MEDICARE: DR. LIA MARIE PARICO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	010085	CT

General Provider Information

NPI Number	:	1376794024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LIA MARIE PARICO DDS

Provider Business Mailing Address
First Line	:	392 SALEM TPKE
Second Line	:	CHILDREN'S DENTAL ASSOCIATES OF NEW LONDON COUNTY, PC
City	:	BOZRAH
State	:	CT
Zip	:	06334-1519
Country	:	US
Telephone Number	:	860-886-5576
Fax Number	:

Provider Business Practice Location Address
First Line	:	392 SALEM TPKE
Second Line	:	CHILDREN'S DENTAL ASSOCIATES OF NEW LONDON COUNTY, PC
City	:	BOZRAH
State	:	CT
Zip	:	06334-1519
Country	:	US
Telephone Number	:	860-886-5576
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2008
Last Update Date	:	01/04/2011

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