NPIMap

Organization Active NPI

Avon Oral and Maxillofacial Surgery, LLP

  • Oral and Maxillofacial Surgery (Dentist)
  • Avon, CT
National Provider Identifier
1801013727
Registry record updated Feb 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
008732 Issued in CT
Legal business name
AVON ORAL AND MAXILLOFACIAL SURGERY, LLP
Practice address
34 Dale Rd
Suite 105
Avon, CT 06001-3659
Phone
(860) 674-8079
Fax
(860) 676-8242
NPI assigned
Apr 20, 2007
Last updated
Feb 8, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2021

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

Authorized official

Name
Ms. Barbara Hinman
Title
Office Manager
Phone
(860) 674-8079

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 008732 CT Primary

Addresses

Primary practice location

34 Dale Rd
Suite 105
Avon, CT 06001-3659

Mailing address

34 Dale Rd
Suite 105
Avon, CT 06001-3659
Phone (860) 674-8079

Other identifiers 5

IdentifierTypeStateIssuer
004397718MedicaidCT
002087329MedicaidCT
001388207MedicaidCT
002064939MedicaidCT
004206977MedicaidCT

National Provider Directory

National Provider Directory

Locations

34 Dale Rd
Ste 105
Avon, CT 06001
Phone (860) 674-8079

Practitioners & affiliated clinicians

Practitioners 4

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": "1177027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612742400000",
    "number": "1801013727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34 DALE RD",
            "address_2": "SUITE 105",
            "city": "AVON",
            "state": "CT",
            "postal_code": "060013659",
            "telephone_number": "860-674-8079",
            "fax_number": "860-676-8242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34 DALE RD",
            "address_2": "SUITE 105",
            "city": "AVON",
            "state": "CT",
            "postal_code": "060013659",
            "telephone_number": "860-674-8079",
            "fax_number": "860-676-8242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVON ORAL AND MAXILLOFACIAL SURGERY, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-20",
        "last_updated": "2021-02-08",
        "certification_date": "2021-02-08",
        "status": "A",
        "authorized_official_last_name": "HINMAN",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "860-674-8079",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CT",
            "license": "008732",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004397718",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002087329",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001388207",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002064939",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004206977",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Avon, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2021; 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.