1467656215 NPI number — MICHELE E SEMONELLI DMD

Table of content: MICHELE E SEMONELLI DMD (NPI 1467656215)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467656215 NPI number — MICHELE E SEMONELLI DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEMONELLI
Provider First Name:
MICHELE
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1467656215
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13 BEXLEY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01749-1129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-562-4755
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 WHALON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FITCHBURG
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01420-7128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-345-6919
Provider Business Practice Location Address Fax Number:
978-345-3770
Provider Enumeration Date:
06/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  20211 , 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)

  • Identifier: 1831242262 . This is a "OFFICE NPI" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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