Provider Demographics
NPI:1336496454
Name:FACIAL SURGERY CENTER
Entity Type:Organization
Organization Name:FACIAL SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT ORAL AND MAXILLOFACIAL SU
Authorized Official - Prefix:DR
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:J
Authorized Official - Last Name:FLORIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:203-261-7800
Mailing Address - Street 1:115 TECHNOLOGY DR
Mailing Address - Street 2:B101
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-6337
Mailing Address - Country:US
Mailing Address - Phone:203-261-7800
Mailing Address - Fax:203-261-8778
Practice Address - Street 1:115 TECHNOLOGY DR
Practice Address - Street 2:B101
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-6337
Practice Address - Country:US
Practice Address - Phone:203-261-7800
Practice Address - Fax:203-261-8778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT82151223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty