Provider Demographics
NPI:1639401219
Name:PALUMBO, SANDRA (RDH)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:PALUMBO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-1918
Mailing Address - Country:US
Mailing Address - Phone:203-931-6025
Mailing Address - Fax:203-931-6083
Practice Address - Street 1:419 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-1918
Practice Address - Country:US
Practice Address - Phone:203-931-6025
Practice Address - Fax:203-931-6083
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003401124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist