NPIMap

Organization Active NPI

Connecticut Center for Oral Facial and Implant Surgery PC

  • Oral and Maxillofacial Surgery Clinic/Center
  • West Hartford, CT
National Provider Identifier
1053782060
Registry record updated Oct 17, 2022
On this page

Key facts

NPPES NPI Registry
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
Last updated
Oct 17, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2022

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.NPI 1023245842
Title
President
Phone
(860) 231-1030

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery Clinic/Center 261QS0112X 011331 CT Primary

Addresses

Primary practice location

80 S Main St
West Hartford, CT 06107-2408

Mailing address

80 S Main St
West Hartford, CT 06107-2408
Phone (860) 231-1030

National Provider Directory

National Provider Directory

Locations

54 Retreat Ave
Hartford, CT 06106
Phone (860) 278-0777

80 S Main St
West Hartford, CT 06107
Phone (860) 231-1030

80 S Main St
Fl 1
West Hartford, CT 06107
Phone (860) 231-1030

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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": []
}

Other providers in West Hartford, CT

Sources for this page

  • 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.