| 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 (10 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 Dentists |
| 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 |
Date of last update: 19 Oct 2024
Sources: Rhode Island Department of State
