Provider Demographics
NPI:1821597022
Name:DYRKACZ, PAUL (DMD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:DYRKACZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 BOOTH RD
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-1951
Mailing Address - Country:US
Mailing Address - Phone:860-593-9197
Mailing Address - Fax:
Practice Address - Street 1:44 DOVER POINT RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-4664
Practice Address - Country:US
Practice Address - Phone:603-740-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH047191223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery