Naushad Ratan Edibam, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

009711 Issued in CT

Practice address

10 Higgins Hwy
#10
Mansfield Center, CT 06250-1437

Phone

(860) 423-2587

NPI assigned

Jul 8, 2007

Sex

Male

Sole proprietor

No

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

• Stamford Oral and Maxillofacial Surgical Arts LLC

  • Oral and Maxillofacial Surgery Clinic/Center
  • Stamford, CT
  • NPI 1720520976
  NPD (past) Authorized official
• Connecticut Oral & Maxillofacial Surgery Centers, LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Meriden, CT
  • NPI 1083818710

  Oral and Maxillofacial Surgery

  NPD (past)
• Stamford Oral & Maxillofacial Surgery Assoc PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Stamford, CT
  • NPI 1063609105

  Oral and Maxillofacial Surgery

  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 30, 2019 through Apr 30, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: nedibam3015@direct.ynhh.org

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 7, 2016.

{
    "created_epoch": "1183852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478476800000",
    "number": "1982802294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 BRIDGE ST",
            "address_2": "#10",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069054501",
            "telephone_number": "203-325-2661",
            "fax_number": "203-323-5611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 HIGGINS HWY",
            "address_2": "#10",
            "city": "MANSFIELD CENTER",
            "state": "CT",
            "postal_code": "062501437",
            "telephone_number": "860-423-2587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDIBAM",
        "first_name": "NAUSHAD",
        "middle_name": "RATAN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-08",
        "last_updated": "2016-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CT",
            "license": "009711",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen V Duhamel, R.N.
• Katherine Ann Dunn, RN
• Cindy Dupointe
• Autumn Dwy, LMSW
• Anna Ebora, LCSW
• Inge-Marie Eigsti, PH.D.
• Claire Ellerbrock, APRN
• Craig Russell Elliott, M.D.
• Sherri Anne Ericksen, DC
• Demitria Estrada, DMD

• All providers in Mansfield Center, CT
• Oral and Maxillofacial Surgery (Dentist) in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.