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

Last updated

Nov 7, 2016By 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 1

Addresses

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

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.

• 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
  NPD (past)
• Connecticut Oral & Maxillofacial Surgery Centers, LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Mansfield Center, CT
  • NPI 1558272237
  NPD (past)
• Stamford Oral & Maxillofacial Surgery Assoc PC

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

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

{
    "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

• Oral and Maxillofacial Surgery (Dentist) in Mansfield Center, CT
• Providers in Mansfield Center, 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 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.