Provider Demographics
NPI:1922166081
Name:SACCOCCIO, STEVEN J (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:SACCOCCIO
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 1:115 BUDLONG RD
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-6429
Mailing Address - Country:US
Mailing Address - Phone:401-944-8100
Mailing Address - Fax:401-946-1060
Practice Address - Street 1:115 BUDLONG RD
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-6429
Practice Address - Country:US
Practice Address - Phone:401-944-8100
Practice Address - Fax:401-946-1060
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI24321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7002480OtherMEDICAL ASSISTANCE