Provider Demographics
NPI:1417328162
Name:CONNECTICUT VALLEY ORAL SURGERY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:CONNECTICUT VALLEY ORAL SURGERY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:EBBIGHAUSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-357-3709
Mailing Address - Street 1:272 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-4122
Mailing Address - Country:US
Mailing Address - Phone:603-357-3709
Mailing Address - Fax:603-352-5722
Practice Address - Street 1:272 MAIN ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-4122
Practice Address - Country:US
Practice Address - Phone:603-357-3709
Practice Address - Fax:603-352-5722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty