Provider Demographics
NPI:1710019658
Name:JR DREW & EP RACCIO, D.M.D.
Entity Type:Organization
Organization Name:JR DREW & EP RACCIO, D.M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:RACCIO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-443-0861
Mailing Address - Street 1:256 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-2050
Mailing Address - Country:US
Mailing Address - Phone:860-443-0861
Mailing Address - Fax:860-443-6065
Practice Address - Street 1:256 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-2050
Practice Address - Country:US
Practice Address - Phone:860-443-0861
Practice Address - Fax:860-443-6065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0054921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty