Provider Demographics
NPI:1487754628
Name:SANFILIPPO, DONNA J
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:J
Last Name:SANFILIPPO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 LAURELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:CT
Mailing Address - Zip Code:06420-3937
Mailing Address - Country:US
Mailing Address - Phone:860-859-0667
Mailing Address - Fax:
Practice Address - Street 1:643 GOLD STAR HWY
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-6267
Practice Address - Country:US
Practice Address - Phone:860-445-8569
Practice Address - Fax:860-446-1890
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT77771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice