Provider Demographics
NPI:1962491803
Name:SORRENTINO, ROBERT R (DMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:R
Last Name:SORRENTINO
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 1:616 VINEYARD POINT RD
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-3252
Mailing Address - Country:US
Mailing Address - Phone:203-458-6385
Mailing Address - Fax:203-782-6389
Practice Address - Street 1:1423 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4411
Practice Address - Country:US
Practice Address - Phone:203-787-6581
Practice Address - Fax:203-782-6389
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT51391223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTT23471Medicare UPIN