Healthcare Provider Details

I. General information

NPI: 1568588036
Provider Name (Legal Business Name): MARIA CIPRIANO-DEFIORE RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 SHELTON AVE
SHELTON CT
06484-2804
US

IV. Provider business mailing address

10 LAZO DR
NORTHFIELD CT
06778-2121
US

V. Phone/Fax

Practice location:
  • Phone: 203-929-6338
  • Fax: 203-929-7619
Mailing address:
  • Phone: 860-283-8514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number005997
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: