Healthcare Provider Details

I. General information

NPI: 1144407016
Provider Name (Legal Business Name): ROSS J. SANFILIPPO, DMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 SHAWS COVE SUITE 203
NEW LONDON CT
06320
US

IV. Provider business mailing address

4 SHAWS COVE SUITE 203
NEW LONDON CT
06320
US

V. Phone/Fax

Practice location:
  • Phone: 860-443-3619
  • Fax: 860-443-1401
Mailing address:
  • Phone: 860-443-3619
  • Fax: 860-443-1401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateCT

VIII. Authorized Official

Name: DR. ROSS J SANFILIPPO
Title or Position: OWNER
Credential:
Phone: 860-443-3619