Provider Demographics
NPI:1427358332
Name:ORAL SURGERY ASSOCIATES
Entity Type:Organization
Organization Name:ORAL SURGERY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:R
Authorized Official - Last Name:BEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:802-464-1425
Mailing Address - Street 1:25 COLDBROOK RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WILMINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05363-9624
Mailing Address - Country:US
Mailing Address - Phone:802-464-1425
Mailing Address - Fax:802-464-3657
Practice Address - Street 1:25 COLDBROOK RD
Practice Address - Street 2:SUITE 2
Practice Address - City:WILMINGTON
Practice Address - State:VT
Practice Address - Zip Code:05363-9624
Practice Address - Country:US
Practice Address - Phone:802-464-1425
Practice Address - Fax:802-464-3657
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORAL SURGERY ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-26
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty