Provider Demographics
NPI:1992840391
Name:DUTCHICK, GEORGE P (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:P
Last Name:DUTCHICK
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 1:2010 PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-1910
Mailing Address - Country:US
Mailing Address - Phone:203-333-3140
Mailing Address - Fax:
Practice Address - Street 1:2010 PARK AVENUE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-1910
Practice Address - Country:US
Practice Address - Phone:203-333-3140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4589122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist