Provider Demographics
NPI:1477757862
Name:DONOFRIO, MELISSA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:DONOFRIO
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 1:26 MIDDLESEX TPKE
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:CT
Mailing Address - Zip Code:06426-1401
Mailing Address - Country:US
Mailing Address - Phone:860-767-9403
Mailing Address - Fax:860-767-9405
Practice Address - Street 1:26 MIDDLESEX TPKE
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:CT
Practice Address - Zip Code:06426-1401
Practice Address - Country:US
Practice Address - Phone:860-767-9403
Practice Address - Fax:860-767-9405
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008525122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist