Provider Demographics
NPI:1942423785
Name:BUONANNO, CONSTANTINE SCOTT (DMD)
Entity Type:Individual
Prefix:DR
First Name:CONSTANTINE
Middle Name:SCOTT
Last Name:BUONANNO
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 1:57 SPENO RDG
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-2835
Mailing Address - Country:US
Mailing Address - Phone:860-436-4021
Mailing Address - Fax:860-828-4180
Practice Address - Street 1:1105 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:CT
Practice Address - Zip Code:06037-2241
Practice Address - Country:US
Practice Address - Phone:860-818-4189
Practice Address - Fax:860-828-4180
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007776122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist