Healthcare Provider Details

I. General information

NPI: 1750301982
Provider Name (Legal Business Name): PAUL A BOCCIARELLI D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 CROMWELL AVE. SUITE 203
ROCKY HILL CT
06067
US

IV. Provider business mailing address

506 CROMWELL AVE SUITE 203
ROCKY HILL CT
06067-1851
US

V. Phone/Fax

Practice location:
  • Phone: 860-529-8582
  • Fax: 860-563-1792
Mailing address:
  • Phone: 860-529-8582
  • Fax: 860-563-1792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number6825
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: