Organization
DR.DENTAL OF DERBY P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ARTHUR REVECHKIS (MANAGING DIRECTOR)
(201) 725-0372
Entity
Organization
Contact information
Practice address
49 PERSHING DR, DERBY, CT 06418-1406
(201) 725-0372
Mailing address
49 PERSHING DR, DERBY, CT 06418-1406
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
010025
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010025
—
CT
Enumeration date
03/21/2013
Last updated
07/05/2013
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