Provider Demographics
NPI:1154344281
Name:SANFILIPPO, ROSS J (DMD)
Entity type:Individual
Prefix:DR
First Name:ROSS
Middle Name:J
Last Name:SANFILIPPO
Suffix:
Gender:M
Credentials:DMD
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Mailing Address - Street 1:4 SHAWS CV
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4956
Mailing Address - Country:US
Mailing Address - Phone:860-443-3619
Mailing Address - Fax:860-443-1401
Practice Address - Street 1:4 SHAWS CV
Practice Address - Street 2:SUITE 203
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4956
Practice Address - Country:US
Practice Address - Phone:860-443-3619
Practice Address - Fax:860-443-1401
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT0077871223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT507666OtherUNITED CONCORDIA
CT507666OtherUNITED CONCORDIA