1326193251 NPI number — VILLAGE DENTAL OF NEW ENGLAND PLLC

Table of content: (NPI 1326193251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326193251 NPI number — VILLAGE DENTAL OF NEW ENGLAND PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VILLAGE DENTAL OF NEW ENGLAND PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LEONARD E DIPAOLO DDS
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326193251
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 EMMONS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02465
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-969-8725
Provider Business Mailing Address Fax Number:
603-382-2052

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
486 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLESLEY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02482
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-969-8725
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DIPAOLO
Authorized Official First Name:
LEONARD
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
617-969-8725

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  16470 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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