Michael William Tichy, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

005931 Issued in CT

Practice address

435 New Haven Ave
Derby, CT 06418-2534

Phone

(203) 735-7500

Fax

(203) 735-0439

NPI assigned

Apr 8, 2009

Last updated

Apr 10, 2009By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1239148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1239321600000",
    "number": "1598908428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "435 NEW HAVEN AVE",
            "city": "DERBY",
            "state": "CT",
            "postal_code": "064182534",
            "telephone_number": "203-735-7500",
            "fax_number": "203-735-0439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 NEW HAVEN AVE",
            "city": "DERBY",
            "state": "CT",
            "postal_code": "064182534",
            "telephone_number": "203-735-7500",
            "fax_number": "203-735-0439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TICHY",
        "first_name": "MICHAEL",
        "middle_name": "WILLIAM",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-04-08",
        "last_updated": "2009-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "005931",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Derby, CT
• Providers in Derby, CT by specialty
• General Practice Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.