Healthcare Provider Details

I. General information

NPI: 1568665305
Provider Name (Legal Business Name): ALBERT JAMES REPICCI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

141 MILBANK AVE
GREENWICH CT
06830-6616
US

IV. Provider business mailing address

141 MILBANK AVE
GREENWICH CT
06830-6616
US

V. Phone/Fax

Practice location:
  • Phone: 203-869-3377
  • Fax: 203-861-0831
Mailing address:
  • Phone: 203-869-3377
  • Fax: 203-861-0831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberCT4338
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: