Provider Demographics
NPI:1881617959
Name:APEX ORAL MAXILLOFACIAL SURGERY
Entity type:Organization
Organization Name:APEX ORAL MAXILLOFACIAL SURGERY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:F
Authorized Official - Last Name:DECOTEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-883-4008
Mailing Address - Street 1:39 SIMON ST
Mailing Address - Street 2:UNIT 11-13
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3046
Mailing Address - Country:US
Mailing Address - Phone:603-883-4008
Mailing Address - Fax:603-881-3822
Practice Address - Street 1:39 SIMON ST
Practice Address - Street 2:UNIT 11-13
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3046
Practice Address - Country:US
Practice Address - Phone:603-883-4008
Practice Address - Fax:603-881-3822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223S0112X
NH21921223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty