Provider Demographics
NPI:1982176343
Name:LYCHEVA, EKATERINA
Entity type:Individual
Prefix:
First Name:EKATERINA
Middle Name:
Last Name:LYCHEVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 NOTT ST
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-1505
Mailing Address - Country:US
Mailing Address - Phone:347-210-4962
Mailing Address - Fax:
Practice Address - Street 1:21 WOODLAND ST STE L-16
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-4318
Practice Address - Country:US
Practice Address - Phone:860-728-6668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12372122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist