Nazeeh Juma Abunasra, DMD
Individual provider Active NPI Oral and Maxillofacial Surgery (Dentist) · South Windsor, CT
NPI 1386679322 · NPPES record last updated Mar 4, 2013
Key facts
- NPI
- 1386679322
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist) 1223S0112X
- License
- 009496 (CT)
- Practice address
- 89 Cornerstone Dr
South Windsor, CT 06074-2373 - Phone
- (917) 892-5431
- NPI assigned
- Jul 11, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151012000982 | CT | Order and Referring Only - Dentist |
8921317033 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 009496 | CT | MD | Oral and Maxillofacial Surgery (Dentist) |
| 21347 | MA | MD | Oral and Maxillofacial Surgery (Dentist) |
| 054511 | NY | MD | Oral and Maxillofacial Surgery (Dentist) |
| 3514 | NH | MD | Student in an Organized Health Care Education/Training Program |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 009496 | CT | Yes |
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 3514 | NH | |
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 054511 | NY | |
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 21347 | MA |
Addresses
Primary practice location
89 Cornerstone Dr
South Windsor, CT 06074-2373
Mailing address
89 Cornerstone Dr
South Windsor, CT 06074-2373
Phone (917) 892-5431
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All providers in South Windsor, CT · Oral and Maxillofacial Surgery (Dentist) in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 4, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.