Provider Demographics
NPI:1942410642
Name:STEPHANIE A. URILLO DDSPC
Entity Type:Organization
Organization Name:STEPHANIE A. URILLO DDSPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:URILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-276-0027
Mailing Address - Street 1:360-15 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-2503
Mailing Address - Country:US
Mailing Address - Phone:860-276-0027
Mailing Address - Fax:860-628-8451
Practice Address - Street 1:360-15 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-2503
Practice Address - Country:US
Practice Address - Phone:860-276-0027
Practice Address - Fax:860-628-8451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT62721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty