Provider Demographics
NPI:1770516452
Name:KARBAN, EDWARD J (DMD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:KARBAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1389 W MAIN ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3104
Mailing Address - Country:US
Mailing Address - Phone:203-573-1427
Mailing Address - Fax:203-574-2460
Practice Address - Street 1:1389 W MAIN ST
Practice Address - Street 2:SUITE 320
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3104
Practice Address - Country:US
Practice Address - Phone:203-573-1427
Practice Address - Fax:203-574-2460
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT77021223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTT72063Medicare UPIN
CT190000901Medicare ID - Type Unspecified