Provider Demographics
NPI:1770629891
Name:CHUPAS, ROBERT MATTHEW (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MATTHEW
Last Name:CHUPAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-3427
Mailing Address - Country:US
Mailing Address - Phone:860-563-0794
Mailing Address - Fax:860-257-1993
Practice Address - Street 1:899 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-3427
Practice Address - Country:US
Practice Address - Phone:860-563-0794
Practice Address - Fax:860-257-1993
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3985122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist