Center for Oral and Implant Surgery of Greenwich, LLC

Primary specialty

Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X

Legal business name

CENTER FOR ORAL AND IMPLANT SURGERY OF GREENWICH, LLC

Practice address

49 Lake Ave
Greenwich, CT 06830-4501

Phone

(203) 661-4231

Fax

(203) 661-0155

NPI assigned

Dec 4, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Michele S. Bergen, DMD, MDNPI 1215929286

Title

Partner

Phone

(203) 661-4231

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Practitioners 1

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

• Michele Shoshana Bergen, D.M.D., M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Greenwich, CT
  • NPI 1215929286
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1259884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263859200000",
    "number": "1194053942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49 LAKE AVE",
            "city": "GREENWICH",
            "state": "CT",
            "postal_code": "068304501",
            "telephone_number": "203-661-4231",
            "fax_number": "203-661-0155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 LAKE AVE",
            "city": "GREENWICH",
            "state": "CT",
            "postal_code": "068304501",
            "telephone_number": "203-661-4231",
            "fax_number": "203-661-0155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR ORAL AND IMPLANT SURGERY OF GREENWICH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-04",
        "last_updated": "2010-01-19",
        "status": "A",
        "authorized_official_last_name": "BERGEN",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "203-661-4231",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, MD"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery Clinic/Center in Greenwich, CT
• Providers in Greenwich, CT by specialty
• 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 Jan 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.