Provider Demographics
NPI:1295021715
Name:DEGOLLADO, AURORA
Entity Type:Individual
Prefix:DR
First Name:AURORA
Middle Name:
Last Name:DEGOLLADO
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:RUTH
Other - Middle Name:AURORA
Other - Last Name:ZAMORA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19 SALISBURY WAY
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1439
Mailing Address - Country:US
Mailing Address - Phone:860-404-2512
Mailing Address - Fax:
Practice Address - Street 1:710 KING ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4477
Practice Address - Country:US
Practice Address - Phone:860-583-8469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT133841223P0221X
CT121611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes1223P0221XDental ProvidersDentistPediatric Dentistry