Healthcare Provider Details

I. General information

NPI: 1821025933
Provider Name (Legal Business Name): PETER M FICALORA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 SCOTT SWAMP RD
FARMINGTON CT
06032-3448
US

IV. Provider business mailing address

353 SCOTT SWAMP RD PO BOX 647
FARMINGTON CT
06032-3448
US

V. Phone/Fax

Practice location:
  • Phone: 860-674-8999
  • Fax: 860-674-8999
Mailing address:
  • Phone: 860-674-8999
  • Fax: 860-674-8999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8522
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: