Healthcare Provider Details

I. General information

NPI: 1407253073
Provider Name (Legal Business Name): WILFREDO L SANCIANCO DMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2014
Last Update Date: 11/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 W SHORE RD
WARWICK RI
02886-7561
US

IV. Provider business mailing address

3411 W SHORE RD
WARWICK RI
02886-7561
US

V. Phone/Fax

Practice location:
  • Phone: 401-737-7716
  • Fax: 401-737-7713
Mailing address:
  • Phone: 401-737-7716
  • Fax: 401-737-7713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number02633
License Number StateRI

VIII. Authorized Official

Name: DR. WILFREDO L. SANCIANCO
Title or Position: DENTIST/PROVIDER
Credential: DMD
Phone: 401-737-7716