NPI 1083977672 · live from the CMS NPI Registry
Jessica Leigh Bogucki, DMD
Dentist in New Haven, CT. National Provider Identifier 1083977672, active.
NPI record
| NPI | 1083977672 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dentist 122300000X |
| Practice location | 921 State St, New Haven, CT 06511 |
| Practice phone | 203-865-2245 |
| Mailing address | 830 Chalkstone Ave, Providence, RI 02908 |
| Enumerated | June 19, 2012 |
| Last updated | November 26, 2024 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist primary | 122300000X | 010957 (CT) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.