Provider Demographics
NPI:1104221738
Name:WILFREDO L SANCIANCO DMD INC
Entity type:Organization
Organization Name:WILFREDO L SANCIANCO DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILFREDO
Authorized Official - Middle Name:LUANING
Authorized Official - Last Name:SANCIANCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-737-7715
Mailing Address - Street 1:3411 W SHORE RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-7561
Mailing Address - Country:US
Mailing Address - Phone:401-737-7715
Mailing Address - Fax:401-734-9580
Practice Address - Street 1:3411 W SHIORE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886
Practice Address - Country:US
Practice Address - Phone:401-737-7715
Practice Address - Fax:401-734-9580
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILFREDO L SANCIANCO DMD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI02633305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization