Connecticut Center for Oral Facial and Implant Surgery PC

Primary specialty

Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X

License

011331 Issued in CT

Legal business name

CONNECTICUT CENTER FOR ORAL FACIAL AND IMPLANT SURGERY PC

Practice address

80 S Main St
West Hartford, CT 06107-2408

Phone

(860) 231-1030

Fax

(860) 231-1032

NPI assigned

Oct 16, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jacob Marshall Gady, D.M.D., M.D.

Title

President

Phone

(860) 231-1030

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Daniel Beauvais, DMD, MD

  • Dentist
  • West Hartford, CT
  • NPI 1568818771
  NPD
• Emily King

  • Oral and Maxillofacial Surgery (Dentist)
  • West Hartford, CT
  • NPI 1740600725
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1444953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665964800000",
    "number": "1053782060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 S MAIN ST",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061072408",
            "telephone_number": "860-231-1030",
            "fax_number": "860-231-1032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 S MAIN ST",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061072408",
            "telephone_number": "860-231-1030",
            "fax_number": "860-231-1032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECTICUT CENTER FOR ORAL FACIAL AND IMPLANT SURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-16",
        "last_updated": "2022-10-17",
        "certification_date": "2022-07-07",
        "status": "A",
        "authorized_official_last_name": "GADY",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "MARSHALL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "860-231-1030",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D., M.D."
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": "CT",
            "license": "011331",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in West Hartford, CT
• Oral and Maxillofacial Surgery Clinic/Center in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.