| NPI | 1992109656 |
|---|---|
| Former Legal Business Name | CONNECTICUT IMPLANT AND ORAL SURGERY SPECIALISTS, LLC |
| Entity Type | Organization |
| Authorized Contact | JORDAN GREENBERG Member/President 914-355-0840 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2014-10-09 |
| Last Update Date | 2014-10-22 |