Healthcare Provider Details

I. General information

NPI: 1750402764
Provider Name (Legal Business Name): ROBERT E CIPRIANO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 MONTGOMERY ST
CHICOPEE MA
01020-1929
US

IV. Provider business mailing address

391 MONTGOMERY ST
CHICOPEE MA
01020-1929
US

V. Phone/Fax

Practice location:
  • Phone: 413-592-8099
  • Fax: 413-592-5839
Mailing address:
  • Phone: 413-592-8099
  • Fax: 413-592-5839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number16813
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: