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

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

CRAIG A. STASULIS DMD, MD, ORAL AND MAXILLOFACIAL SURGERY, INC

Practice address

435 Willard Ave Unit D
Newington, CT 06111-2318

Phone

(860) 796-1329

NPI assigned

Oct 27, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Craig Allen Stasulis, DMD, MD

Title

Owner

Phone

(860) 500-7995

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1572134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582588800000",
    "number": "1881237402",
    "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": {
        "organization_name": "CRAIG A. STASULIS DMD, MD, ORAL AND MAXILLOFACIAL SURGERY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-27",
        "last_updated": "2020-02-25",
        "certification_date": "2020-02-25",
        "status": "A",
        "authorized_official_last_name": "STASULIS",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-500-7995",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, MD"
    },
    "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": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Newington, CT
• Providers in Newington, CT by specialty
• Oral and Maxillofacial Surgery (Dentist) in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2020; 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.