MEDICARE: DR. CONSTANTINE SCOTT BUONANNO DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	007776	CT

General Provider Information

NPI Number	:	1942423785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CONSTANTINE SCOTT BUONANNO DMD

Provider Business Mailing Address
First Line	:	57 SPENO RDG
Second Line	:
City	:	ROCKY HILL
State	:	CT
Zip	:	06067-2835
Country	:	US
Telephone Number	:	860-436-4021
Fax Number	:	860-828-4180

Provider Business Practice Location Address
First Line	:	1105 FARMINGTON AVE
Second Line	:
City	:	KENSINGTON
State	:	CT
Zip	:	06037-2241
Country	:	US
Telephone Number	:	860-818-4189
Fax Number	:	860-828-4180

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	07/08/2007

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