Healthcare Provider Details

I. General information

NPI: 1396775375
Provider Name (Legal Business Name): JOSEPH F PIECUCH M.D., D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE
FARMINGTON CT
06030-0001
US

IV. Provider business mailing address

263 FARMINGTON AVE
FARMINGTON CT
06030-2212
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-2583
  • Fax: 860-679-1920
Mailing address:
  • Phone: 860-679-7503
  • Fax: 860-679-1610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5489
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: