East Lyme Oral and Maxillofacial Surgery

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

007384 Issued in CT

Legal business name

EAST LYME ORAL AND MAXILLOFACIAL SURGERY

Practice address

314 Flanders Rd
Suite 1B
East Lyme, CT 06333-1727

Phone

(860) 739-3133

Fax

(860) 739-3131

NPI assigned

Nov 8, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Kirk Fred Engel, DMDNPI 1659376507

Title

Member and Owner

Phone

(860) 739-3133

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

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

• Kirk F. Engel, D.M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • East Lyme, CT
  • NPI 1659376507

  Oral and Maxillofacial Surgery

  NPD (past) Authorized official
• Seth J Matton, MD, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • East Lyme, CT
  • NPI 1609165521

  Oral and Maxillofacial Surgery

  NPD (past)

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188000000000",
    "number": "1205906369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 FLANDERS RD",
            "address_2": "SUITE 1B",
            "city": "EAST LYME",
            "state": "CT",
            "postal_code": "063331727",
            "telephone_number": "860-739-3133",
            "fax_number": "860-739-3131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 FLANDERS RD",
            "address_2": "SUITE 1B",
            "city": "EAST LYME",
            "state": "CT",
            "postal_code": "063331727",
            "telephone_number": "860-739-3133",
            "fax_number": "860-739-3131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST LYME ORAL AND MAXILLOFACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2007-08-25",
        "status": "A",
        "authorized_official_last_name": "ENGEL",
        "authorized_official_first_name": "KIRK",
        "authorized_official_middle_name": "FRED",
        "authorized_official_title_or_position": "MEMBER AND OWNER",
        "authorized_official_telephone_number": "860-739-3133",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CT",
            "license": "007384",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI FOR DR. KIRK ENGEL",
            "identifier": "1659376507",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Illene Chelsea Dezfuli, PHARMD
• Susan D Diaz
• Dr. Robert E. Levin
• James Anthony Dyer, DMD
• East Lyme Board of Ed
• Elevating Wellness LLC
• Kirk F. Engel, D.M.D.
• Richard Dale England, M.D., PH.D.
• Stefania Falvo, OTR/L
• Peter John Famiglietti, MD

• All providers in East Lyme, CT
• Oral and Maxillofacial Surgery (Dentist) in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2007; 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.