Healthcare Provider Details

I. General information

NPI: 1386743102
Provider Name (Legal Business Name): WILFREDO LUANCING SANCIANCO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
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

17 JODIE BETH DR
EAST GREENWICH RI
02818-1521
US

V. Phone/Fax

Practice location:
  • Phone: 401-737-7715
  • Fax:
Mailing address:
  • Phone: 401-398-1072
  • Fax: 401-398-1072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number02633
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: