Richard G Bevilacqua, D.M.D., M.D.
Dentist, Oral and Maxillofacial Surgery in Glastonbury, CT. Individual provider (NPI-1).
NPI number1477543767
StatusActive
Last updated in NPPESDec 10, 2008
Details
- NPI
- 1477543767
- Entity type
- Individual (NPI-1)
- Name
- Richard G Bevilacqua
- Credential
- D.M.D., M.D.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Oct 27, 2005
- Last updated
- Dec 10, 2008
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - MAXILLOFACIAL SURGERY
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223S0112X | Dentist, Oral and Maxillofacial Surgery | 008006 | CT | Yes |
Practice location
71a Naubuc AveGlastonbury, CT 06033-2006
Phone 860-633-3519 · Fax 860-633-3510
Mailing address
71a Naubuc AveGlastonbury, CT 06033-2006
Phone 860-633-3519 · Fax 860-633-3510
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