Healthcare Provider Details

I. General information

NPI: 1992843437
Provider Name (Legal Business Name): PAUL MICHAEL CIUCI DMD, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2007
Last Update Date: 04/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GOLDEN HILL ST
MILFORD CT
06460-4630
US

IV. Provider business mailing address

1 GOLDEN HILL ST
MILFORD CT
06460-4630
US

V. Phone/Fax

Practice location:
  • Phone: 203-874-1664
  • Fax: 203-877-2027
Mailing address:
  • Phone: 203-874-1664
  • Fax: 203-877-2027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number009672
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number45907
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: