Provider Demographics
NPI:1538491170
Name:SANTANIELLO, THOMAS C (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:C
Last Name:SANTANIELLO
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:PO BOX 467
Mailing Address - Street 2:16 RIVER STREET
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06852
Mailing Address - Country:US
Mailing Address - Phone:203-866-8779
Mailing Address - Fax:203-866-8779
Practice Address - Street 1:16 RIVER STREET
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850
Practice Address - Country:US
Practice Address - Phone:203-866-8779
Practice Address - Fax:203-866-8779
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5254122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist