Provider Demographics
NPI:1114029246
Name:CHISILENCO, ANNA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:M
Last Name:CHISILENCO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-8904
Mailing Address - Country:US
Mailing Address - Phone:203-877-0377
Mailing Address - Fax:203-877-0377
Practice Address - Street 1:67 CHERRY ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-8904
Practice Address - Country:US
Practice Address - Phone:203-877-0377
Practice Address - Fax:203-877-0377
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0088611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice