Craig Allen Stasulis, D.M.D., M.D.

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

48060 Issued in CT

Practice address

435 Willard Ave Unit D
Newington, CT 06111-2318

Phone

(860) 796-1329

NPI assigned

Aug 30, 2007

Last updated

Oct 28, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Feb 27, 2020 through Feb 27, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Craig a. Stasulis DMD, MD, Oral and Maxillofacial Surgery, Inc

  • Oral and Maxillofacial Surgery (Dentist)
  • Newington, CT
  • NPI 1881237402
  Authorized official Same address or phone
• University of Connecticut Health Center

  dba University Physicians

  • General Practice Physician
  • Farmington, CT
  • NPI 1720083769
  NPD (past)

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

{
    "created_epoch": "1188432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572220800000",
    "number": "1649464991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "435 WILLARD AVE UNIT D",
            "city": "NEWINGTON",
            "state": "CT",
            "postal_code": "061112318",
            "telephone_number": "860-796-1329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 WILLARD AVE UNIT D",
            "city": "NEWINGTON",
            "state": "CT",
            "postal_code": "061112318",
            "telephone_number": "860-796-1329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STASULIS",
        "first_name": "CRAIG",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "D.M.D., M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-30",
        "last_updated": "2019-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CT",
            "license": "009948",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "CT",
            "license": "48060",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carol Specter
• Michael Srokowski, DPT, OCS, FAAOMPT
• Robert Stair, PT
• Starling Physicians PC
• Starting Point, LLC
• State of Connecticut (DBA Cedarcrest Hospital)
• State of CT. - Office of the Comptroller (North Region-Shape House- 87 Mtn. Road)
• State of CT. - Office of the Comptroller (North Region - Main Bldg-67 Mtn. Road)
• State of CT. - Office of the Comptroller (North Region - Richard House- 85 Mtn. Rd.)
• State of CT. - Office of the Comptroller (North Region - 81 Mtn. Rd. - Laurel Cottage)

• Oral & Maxillofacial Surgery (D.M.D.) in Newington, CT
• Providers in Newington, CT by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.