Provider Demographics
NPI:1063530228
Name:CIANCIULLI, HENRY DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:DAVID
Last Name:CIANCIULLI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:934 SMALL DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-8404
Mailing Address - Country:US
Mailing Address - Phone:252-331-4881
Mailing Address - Fax:
Practice Address - Street 1:527 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-8327
Practice Address - Country:US
Practice Address - Phone:252-331-4881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC54801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice