Provider Demographics
NPI:1922047349
Name:DEFILIPPO, JAMES SALVATORE (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:SALVATORE
Last Name:DEFILIPPO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20-30 BEAVER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-2242
Mailing Address - Country:US
Mailing Address - Phone:860-721-7428
Mailing Address - Fax:
Practice Address - Street 1:20-30 BEAVER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-2242
Practice Address - Country:US
Practice Address - Phone:860-721-7428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT65321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice