Healthcare Provider Details

I. General information

NPI: 1841321023
Provider Name (Legal Business Name): THOMAS MICHAEL DECOSTE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

839 BROAD ST
EAST WEYMOUTH MA
02189-2030
US

IV. Provider business mailing address

29 BIG ROCK LN
HANSON MA
02341-1617
US

V. Phone/Fax

Practice location:
  • Phone: 781-331-6666
  • Fax: 781-331-9796
Mailing address:
  • Phone: 781-293-6196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14827
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: