Healthcare Provider Details

I. General information

NPI: 1205233202
Provider Name (Legal Business Name): DONNA L PASCHALIDES PHDH, RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2014
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 MAIN ST
MARLBOROUGH MA
01572
US

IV. Provider business mailing address

98 STOW RD
MARLBOROUGH MA
01752
US

V. Phone/Fax

Practice location:
  • Phone: 508-485-6492
  • Fax:
Mailing address:
  • Phone: 774-249-9884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH87679
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: