# CONNECTICUT MAXILLOFACIAL ASSOCIATES, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Dr. Richard Bevilacqua
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174768741
- **Authorized official:** RICHARD G BEVILACQUA D.M.D., M.D. (PRESIDENT)
- **Authorized official phone:** (860) 633-3519

## Contact information

- **Practice address:** 71A NAUBUC AVE, GLASTONBURY, CT 06033-2006
- **Practice address phone:** (860) 633-3519
- **Practice address fax:** (860) 633-3510
- **Mailing address:** 71A NAUBUC AVE, GLASTONBURY, CT 06033-2006
- **Mailing address phone:** (860) 633-3519
- **Mailing address fax:** (860) 633-3510

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 133645 | CT | Yes |

## Other

- **Enumeration date:** 12/10/2008
- **Last updated:** 12/30/2008