Provider Demographics
NPI:1437160702
Name:FIORILLO, SUSAN C (GENERAL DENTISTRY)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
Last Name:FIORILLO
Suffix:
Gender:F
Credentials:GENERAL DENTISTRY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WINTHROP ST
Mailing Address - Street 2:VERNON MEDICAL CENTER 1
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-4435
Mailing Address - Country:US
Mailing Address - Phone:508-756-0990
Mailing Address - Fax:508-757-2687
Practice Address - Street 1:10 WINTHROP ST
Practice Address - Street 2:VERNON MEDICAL CENTER 1
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-4435
Practice Address - Country:US
Practice Address - Phone:508-756-0990
Practice Address - Fax:508-757-2687
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14547122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA14547OtherALTUS DENTAL
MA14547OtherCMSP
MA1300709Medicaid
MA1300709OtherCMSP-GROUP
WI14547OtherDELTA DENTAL
MAY10141OtherBCBS DENTAL-GROUP
MA14547OtherANTHEM BCBS DENTAL
MA14547OtherBCBS DENTAL
MA14547OtherDELTA DENTAL
MA14547OtherANTHEM BLUECARE
MA14547OtherAMERITAS
WI14547OtherDELTA DENTAL