Provider Demographics
NPI:1093060279
Name:DEFLORIO, DARA PAULA (DMD)
Entity Type:Individual
Prefix:MS
First Name:DARA
Middle Name:PAULA
Last Name:DEFLORIO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 SHAKER ROAD
Mailing Address - Street 2:DENTAL ROOM
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06092
Mailing Address - Country:US
Mailing Address - Phone:860-763-6187
Mailing Address - Fax:860-763-6187
Practice Address - Street 1:200 BIRNIE AVENUE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1102
Practice Address - Country:US
Practice Address - Phone:860-763-6187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN177281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice