Provider Demographics
NPI:1871962084
Name:SANSOUCI, CATHRYN ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:CATHRYN
Middle Name:ANN
Last Name:SANSOUCI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CATHRYN
Other - Middle Name:ANN
Other - Last Name:PUMILIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:73 ROBERT ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740
Mailing Address - Country:US
Mailing Address - Phone:508-999-4949
Mailing Address - Fax:
Practice Address - Street 1:73 ROBERT ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-2770
Practice Address - Country:US
Practice Address - Phone:508-999-4949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019022372122300000X
MADN212881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist