Provider Demographics
NPI:1265923460
Name:DELUCA, SCHUYLER (DDS)
Entity type:Individual
Prefix:DR
First Name:SCHUYLER
Middle Name:
Last Name:DELUCA
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 1:428 N CANTERBURY RD
Mailing Address - Street 2:
Mailing Address - City:CANTERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06331-1213
Mailing Address - Country:US
Mailing Address - Phone:860-373-8347
Mailing Address - Fax:
Practice Address - Street 1:1 KNEELAND ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1527
Practice Address - Country:US
Practice Address - Phone:617-636-6828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT124661223G0001X
MADN1858801122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice