Provider Demographics
NPI:1386743102
Name:SANCIANCO, WILFREDO LUANCING (DMD)
Entity type:Individual
Prefix:DR
First Name:WILFREDO
Middle Name:LUANCING
Last Name:SANCIANCO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 JODIE BETH DR
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-1521
Mailing Address - Country:US
Mailing Address - Phone:401-398-1072
Mailing Address - Fax:401-398-1072
Practice Address - Street 1:3411 W SHORE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-7561
Practice Address - Country:US
Practice Address - Phone:401-737-7715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI026331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice