Healthcare Provider Details

I. General information

NPI: 1831190693
Provider Name (Legal Business Name): ANASTASIA FOUFAS D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 WASHINGTON ST
FOXBORO MA
02035-1332
US

IV. Provider business mailing address

113 WASHINGTON ST
FOXBORO MA
02035-1332
US

V. Phone/Fax

Practice location:
  • Phone: 508-543-7774
  • Fax: 508-543-7747
Mailing address:
  • Phone: 508-543-7774
  • Fax: 508-543-7747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number21168
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: