Provider Demographics
NPI:1457542664
Name:CENTER FOR ORAL & IMPLANT SURGERY, P.C
Entity Type:Organization
Organization Name:CENTER FOR ORAL & IMPLANT SURGERY, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL J
Authorized Official - Middle Name:
Authorized Official - Last Name:SAFIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-925-8700
Mailing Address - Street 1:2 TRAP FALLS RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-4616
Mailing Address - Country:US
Mailing Address - Phone:203-925-8700
Mailing Address - Fax:203-925-8770
Practice Address - Street 1:2 TRAP FALLS RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4616
Practice Address - Country:US
Practice Address - Phone:203-925-8700
Practice Address - Fax:203-925-8770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0086601223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U96580Medicare UPIN