Provider Demographics
NPI:1235257148
Name:ORAL & MAXILLOFACIAL SURGERY ASSOCIATES OF GREATER NEW HAVEN, P.C.
Entity Type:Organization
Organization Name:ORAL & MAXILLOFACIAL SURGERY ASSOCIATES OF GREATER NEW HAVEN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:SKOPE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-865-0807
Mailing Address - Street 1:136 SHERMAN AVE
Mailing Address - Street 2:SUITE #402
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5238
Mailing Address - Country:US
Mailing Address - Phone:203-865-0807
Mailing Address - Fax:203-562-4922
Practice Address - Street 1:136 SHERMAN AVE
Practice Address - Street 2:SUITE #402
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5238
Practice Address - Country:US
Practice Address - Phone:203-865-0807
Practice Address - Fax:203-562-4922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0051981223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC01125Medicare ID - Type Unspecified