Healthcare Provider Details

I. General information

NPI: 1710273032
Provider Name (Legal Business Name): JUSTIN MICHAEL CIFUNI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 06/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E NEWTON ST FL 7
BOSTON MA
02118-2308
US

IV. Provider business mailing address

888 COMMONWEALTH AVE FL 2
BOSTON MA
02215-1205
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-4636
  • Fax: 617-638-5322
Mailing address:
  • Phone: 617-353-3565
  • Fax: 617-358-1170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1855719
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: