Provider Demographics
NPI:1982802294
Name:EDIBAM, NAUSHAD RATAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:NAUSHAD
Middle Name:RATAN
Last Name:EDIBAM
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 1:27 BRIDGE ST
Mailing Address - Street 2:#10
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-4501
Mailing Address - Country:US
Mailing Address - Phone:203-325-2661
Mailing Address - Fax:203-323-5611
Practice Address - Street 1:10 HIGGINS HWY
Practice Address - Street 2:#10
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250-1437
Practice Address - Country:US
Practice Address - Phone:860-423-2587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-08
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0097111223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery