Provider Demographics
NPI:1750301982
Name:BOCCIARELLI, PAUL A (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:BOCCIARELLI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:506 CROMWELL AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-1851
Mailing Address - Country:US
Mailing Address - Phone:860-529-8582
Mailing Address - Fax:860-563-1792
Practice Address - Street 1:506 CROMWELL AVE.
Practice Address - Street 2:SUITE 203
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067
Practice Address - Country:US
Practice Address - Phone:860-529-8582
Practice Address - Fax:860-563-1792
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT68251223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology