| Dr. Richard Bevilacqua | |
|
71a Naubuc Ave Glastonbury CT 06033-2006 | |
| (860) 633-3519 | |
| (860) 633-3510 |
| Full Name | Dr. Richard Bevilacqua |
|---|---|
| Speciality | Dentist |
| Location | 71a Naubuc Ave, Glastonbury, Connecticut |
| Authorized Official Name and Position | Richard G Bevilacqua (PRESIDENT) |
| Authorized Official Contact | 8606333519 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Richard Bevilacqua 71a Naubuc Ave Glastonbury CT 06033-2006 Ph: (860) 633-3519 | Dr. Richard Bevilacqua 71a Naubuc Ave Glastonbury CT 06033-2006 Ph: (860) 633-3519 |
| NPI Number | 1174768741 |
|---|---|
| Provider Enumeration Date | 12/10/2008 |
| Last Update Date | 12/30/2008 |
| Medicare PECOS PAC ID | 8426107921 |
|---|---|
| Medicare Enrollment ID | O20090512000362 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174768741 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 133645 (Connecticut) | Primary |
| Provider Name | Richard G Bevilacqua |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1477543767 PECOS PAC ID: 6709935208 Enrollment ID: I20090512000346 |
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