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General NPI Number Information
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NPI Number | 1982176343
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Entity Type | Individual
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Provider Name | EKATERINA LYCHEVA
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Gender | Female
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Dates
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Enumeration Date | 12/26/2018
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Last Update Date | 12/26/2018
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Provider Practice Location Address
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Address Line | 21 WOODLAND ST STE L-16
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City | HARTFORD
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State | CT
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Zip | 06105-4318
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Country | US
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Telephone | 860-728-6668
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Fax |
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Provider Business Mailing Address
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Address Line | 495 NOTT ST
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City | WETHERSFIELD
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State | CT
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Zip | 06109-1505
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Country | US
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Telephone | 347-210-4962
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12372
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License Number State | CT
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