Provider Demographics
NPI:1730308560
Name:CIANCIULLI, VINCENT (DMD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:CIANCIULLI
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 1:815 HARTFORD TPKE
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-4201
Mailing Address - Country:US
Mailing Address - Phone:860-444-0625
Mailing Address - Fax:860-442-7740
Practice Address - Street 1:815 HARTFORD TPKE
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-4201
Practice Address - Country:US
Practice Address - Phone:860-444-0625
Practice Address - Fax:860-442-7740
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT51401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice