Healthcare Provider Details

I. General information

NPI: 1487731857
Provider Name (Legal Business Name): LOUIS ANDREW PANCHERI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 SALEM STREET
MEDFORD MA
02155
US

IV. Provider business mailing address

265 SALEM STREET
MEDFORD MA
02155
US

V. Phone/Fax

Practice location:
  • Phone: 781-393-0144
  • Fax:
Mailing address:
  • Phone: 781-393-0144
  • Fax: 781-393-0144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number19328
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0483741
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: