Healthcare Provider Details

I. General information

NPI: 1477583862
Provider Name (Legal Business Name): NICHOLAS A CUCHARALE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 STONY HILL RD
BETHEL CT
06801-1063
US

IV. Provider business mailing address

2 STONY HILL RD
BETHEL CT
06801-1063
US

V. Phone/Fax

Practice location:
  • Phone: 203-792-2263
  • Fax: 203-792-2878
Mailing address:
  • Phone: 203-792-2263
  • Fax: 203-792-2878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number6489
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: