Provider Demographics
NPI:1467976688
Name:PIETRUCHA, EMILY JEAN (DMD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JEAN
Last Name:PIETRUCHA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 STONEHEDGE DR
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-2360
Mailing Address - Country:US
Mailing Address - Phone:802-733-7162
Mailing Address - Fax:
Practice Address - Street 1:1173 WHIPPLE ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02841-1632
Practice Address - Country:US
Practice Address - Phone:401-841-2542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-30
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016.01321801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty