NPIMap

Organization Active NPI

Connecticut Valley Oral Surgery Associates, PC

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Brattleboro, VT
National Provider Identifier
1912928946
Registry record updated Dec 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
Legal business name
CONNECTICUT VALLEY ORAL SURGERY ASSOCIATES, PC
Practice address
368 Canal St
Brattleboro, VT 05301-6618
Phone
(802) 254-9418
Fax
(802) 254-2563
NPI assigned
Jul 23, 2006
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 & Maxillofacial Surgery (D.M.D.)Group: 193200000X MULTI-SPECIALTY GROUP 204E00000X Primary

Addresses

Primary practice location

368 Canal St
Brattleboro, VT 05301-6618

Mailing address

368 Canal St
Brattleboro, VT 05301
Phone (802) 254-9418

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070206000239 VT Part B Supplier - Clinic/Group Practice 0648272534 Receives reassigned benefits from 4 practitioners
Practice locations: Brattleboro, VT

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

368 Canal St
Brattleboro, VT 05301
Phone (802) 254-9418

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1153612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671062400000",
    "number": "1912928946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "368 CANAL ST",
            "city": "BRATTLEBORO",
            "state": "VT",
            "postal_code": "05301",
            "telephone_number": "802-254-9418",
            "fax_number": "802-254-2563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "368 CANAL ST",
            "city": "BRATTLEBORO",
            "state": "VT",
            "postal_code": "053016618",
            "telephone_number": "802-254-9418",
            "fax_number": "802-254-2563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECTICUT VALLEY ORAL SURGERY ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-23",
        "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": "204E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brattleboro, VT

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.