Provider Demographics
NPI:1053951350
Name:CONNECTICUT ORAL SURGERY AND IMPLANT CENTER, PLLC
Entity type:Organization
Organization Name:CONNECTICUT ORAL SURGERY AND IMPLANT CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DMD
Authorized Official - Phone:860-578-0436
Mailing Address - Street 1:66 WILDCAT SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2484
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:314 FLANDERS RD STE 1B
Practice Address - Street 2:
Practice Address - City:EAST LYME
Practice Address - State:CT
Practice Address - Zip Code:06333-1727
Practice Address - Country:US
Practice Address - Phone:860-739-3133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1609165521Medicaid