Provider Demographics
NPI:1457731135
Name:SOUTHINGTON ORAL & MAXILLOFACIAL SURGEONS, PC
Entity Type:Organization
Organization Name:SOUTHINGTON ORAL & MAXILLOFACIAL SURGEONS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHEINTOP
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-276-0225
Mailing Address - Street 1:256 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-2524
Mailing Address - Country:US
Mailing Address - Phone:860-276-0225
Mailing Address - Fax:860-276-0368
Practice Address - Street 1:256 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-2524
Practice Address - Country:US
Practice Address - Phone:860-276-0225
Practice Address - Fax:860-276-0368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT73021223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty