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Eliane Hermes Dutra

Dentist

Dental Providers

263 Farmington Ave, Farmington, CT 06030-0001

PECOS Enrollment

This provider is enrolled in PECOS as ELIANE DUTRA.

Based on the most recent information from CMS, provider Eliane Hermes Dutra is legally eligible to order and refer claims for Part B, HHA and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1659711620
Provider Type
Individual
Full Name
Dutra, Eliane Hermes
Credential
DDS

Gender
Female
Sole Proprietor
No
Enumeration Date
7/4/2013
Last Updated
10/26/2016

Contact Information

Practice Location

263 Farmington Ave, Farmington, CT 06030-0001

(860) 679-2207

(860) 679-1899

Mailing Location

100 Trumbull St Apt 301, Hartford, CT 06103-2430

(914) 255-0258

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 1223X0400X Primary	Description Dentist Dental Providers	License 11733 Connecticut

Eliane Hermes Dutra

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Yadav, Sumit

Azami, Niloufar

Upadhyay, Madhur

Nanda, Ravindra

Janakiraman, Nandakumar

Chandhoke, Taranpreet

Faedo, Volmir Antonio

Banankhah, Sina

Uribe, Flavio

Grover, Shaifali