Provider Demographics
NPI:1285310706
Name:PAOLUCCI, PENELOPE O'SULLIVAN (DMD)
Entity type:Individual
Prefix:DR
First Name:PENELOPE
Middle Name:O'SULLIVAN
Last Name:PAOLUCCI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:PENELOPE
Other - Middle Name:MARIE
Other - Last Name:O'SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:80 BROAD ST UNIT 307
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110-3539
Mailing Address - Country:US
Mailing Address - Phone:603-770-2331
Mailing Address - Fax:
Practice Address - Street 1:1 RANDALL SQ STE 305
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2774
Practice Address - Country:US
Practice Address - Phone:401-521-5528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN036641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice