NPIMap

Organization Active NPI

Connecticut Valley Oral Surgery Associates, P.C.

  • Oral and Maxillofacial Surgery (Dentist)
  • Keene, NH
National Provider Identifier
1417328162
Registry record updated Dec 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
CONNECTICUT VALLEY ORAL SURGERY ASSOCIATES, P.C.
Practice address
272 Main St
Keene, NH 03431-4122
Phone
(603) 357-3709
Fax
(603) 352-5722
NPI assigned
Oct 7, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2022

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

Authorized official

Name
Candy Ebbighausen
Title
Administrator
Phone
(603) 357-3709

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X Primary

Addresses

Primary practice location

272 Main St
Keene, NH 03431-4122

Mailing address

272 Main St
Keene, NH 03431-4122
Phone (603) 357-3709

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160205000299 NH Part B Supplier - Clinic/Group Practice 0648272534 Receives reassigned benefits from 4 practitioners
Practice locations: Keene, NH

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Connecticut Valley Oral Surgery Associates PC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

272 Main St
Ste 1
Keene, NH 03431
Phone (603) 357-3709

Practitioners & affiliated clinicians

Practitioners 7

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": "1444176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671062400000",
    "number": "1417328162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "272 MAIN ST",
            "city": "KEENE",
            "state": "NH",
            "postal_code": "034314122",
            "telephone_number": "603-357-3709",
            "fax_number": "603-352-5722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "272 MAIN ST",
            "city": "KEENE",
            "state": "NH",
            "postal_code": "034314122",
            "telephone_number": "603-357-3709",
            "fax_number": "603-352-5722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECTICUT VALLEY ORAL SURGERY ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-07",
        "last_updated": "2022-12-15",
        "certification_date": "2022-12-15",
        "status": "A",
        "authorized_official_last_name": "EBBIGHAUSEN",
        "authorized_official_first_name": "CANDY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "603-357-3709"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Keene, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2022; 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.