Individual
PAUL C PERACCHIO
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
945 MAIN ST, SUITE 310, MANCHESTER, CT 06040-6064
(860) 647-9926
(860) 645-7723
Mailing address
31 HANOVER FARMS RD, BOLTON, CT 06043-7647
(860) 643-9229
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
7708
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020007708CT01
ANTHEM BLUE CROSS
CT
01
—
2V5967
HEALTHNET
CT
01
—
762391
CONNECTICARE
CT
01
—
P3603721
OXFORD
CT
Enumeration date
03/29/2006
Last updated
07/08/2007
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