Provider Demographics
NPI:1609928704
Name:QUATROCELLI, STEPHEN RUDOLPH (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:RUDOLPH
Last Name:QUATROCELLI
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 1:360 TOLLAND TPKE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-1771
Mailing Address - Country:US
Mailing Address - Phone:860-646-4811
Mailing Address - Fax:860-645-0882
Practice Address - Street 1:360 TOLLAND TPKE
Practice Address - Street 2:SUITE 2A
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-1771
Practice Address - Country:US
Practice Address - Phone:860-646-4811
Practice Address - Fax:860-645-0882
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT51621223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics