Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 5191 | CT |
NPI | 1245446863 |
---|---|
Provider Name | Dr. Peter Franklin Pasciucco |
First Address | Hartford, CT 06151-0001 |
Second Address | Hartford, CT 06102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 01/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002051910 | (05) | CT |
T22456 | (02) | CT |