| Name: | Wilfredo L Sancianco DMD Inc |
| Jurisdiction: | Rhode Island |
| Entity type: | Professional Service Corporation |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 12 Sep 2014 (11 years ago) |
| Date of Dissolution: | 15 Nov 2018 (6 years ago) |
| Date of Status Change: | 15 Nov 2018 (6 years ago) |
| Identification Number: | 000981382 |
| ZIP code: | 02818 |
| County: | Kent County |
| Principal Address: | 17 JODIE BETH DRIVE, EAST GREENWICH, RI, 02818, USA |
| Purpose: | DENTISTRY |
NAICS
621210 Offices of DentistsThis industry comprises establishments of health practitioners having the degree of D.M.D. (Doctor of Dental Medicine), D.D.S. (Doctor of Dental Surgery), or D.D.Sc. (Doctor of Dental Science) primarily engaged in the independent practice of general or specialized dentistry or dental surgery. These practitioners operate private or group practices in their own offices (e.g., centers, clinics) or in the facilities of others, such as hospitals or HMO medical centers. They can provide either comprehensive preventive, cosmetic, or emergency care, or specialize in a single field of dentistry. Learn more at the U.S. Census Bureau
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1407253073 | 2014-11-26 | 2014-11-26 | 3411 W SHORE RD, WARWICK, RI, 028867561, US | 3411 W SHORE RD, WARWICK, RI, 028867561, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 401-737-7716 |
| Fax | 4017377713 |
Authorized person
| Name | DR. WILFREDO L. SANCIANCO |
| Role | DENTIST/PROVIDER |
| Phone | 4017377716 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| License Number | 02633 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1104221738 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| MING YU | Agent | 3945 POST ROAD, WARWICK, RI, 02886, USA |
| Name | Role | Address |
|---|---|---|
| WILFREDO L SANCIANCO | PRESIDENT | 17 JODIE BETH DR EAST GREENWICH, RI 02818 USA |
| Name | Role | Address |
|---|---|---|
| WILFREDO L SANCIANCO | SECRETARY | 17 JODIE BETH DR EASH GREENWICH, RI 02818 USA |
| Name | Role | Address |
|---|---|---|
| CED D SANCIANCO | TRESURER | 17 JODIE BETH DR EAST GREENWICH, RI 02818 USA |
| Number | Name | File Date |
|---|---|---|
| 201881286420 | Revocation Certificate For Failure to File the Annual Report for the Year | 2018-11-15 |
| 201875618400 | Revocation Notice For Failure to File An Annual Report | 2018-08-24 |
| 201734285020 | Statement of Change of Registered/Resident Agent | 2017-02-17 |
| 201734283710 | Annual Report | 2017-02-17 |
| 201733582210 | Revocation Notice For Failure to Maintain a Registered Office | 2017-02-06 |
| 201731258810 | Registered Office Not Maintained | 2017-02-01 |
| 201602074040 | Annual Report | 2016-07-14 |
| 201601622620 | Revocation Notice For Failure to File An Annual Report | 2016-07-07 |
| 201565330290 | Annual Report | 2015-07-17 |
| 201564635260 | Revocation Notice For Failure to File An Annual Report | 2015-07-09 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 8341677208 | 2020-04-28 | 0165 | PPP | 1120 TOLL GATE RD, WARWICK, RI, 02886-4443 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 4708028610 | 2021-03-18 | 0165 | PPS | 1120 Toll Gate Rd Ste B, Warwick, RI, 02886-0690 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Date of last update: 19 Oct 2024
Sources: Rhode Island Department of State
