Provider Demographics
NPI:1275619900
Name:PAOLUCCI, ANTHONY DAVID (DMD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:DAVID
Last Name:PAOLUCCI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-2704
Mailing Address - Country:US
Mailing Address - Phone:401-521-5528
Mailing Address - Fax:
Practice Address - Street 1:931 SMITH ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-2704
Practice Address - Country:US
Practice Address - Phone:401-521-5528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI2160122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist