Provider Demographics
NPI:1295902443
Name:SPONZO, THOMAS S (DMD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:S
Last Name:SPONZO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:THOMAS
Other - Middle Name:S
Other - Last Name:SPONZO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1299 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4302
Mailing Address - Country:US
Mailing Address - Phone:860-563-0375
Mailing Address - Fax:
Practice Address - Street 1:1299 SILAS DEANE HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4302
Practice Address - Country:US
Practice Address - Phone:860-563-0375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT58131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice