Healthcare Provider Details

I. General information

NPI: 1114190139
Provider Name (Legal Business Name): FREDERICK J. INSOGNA, D.M.D.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 HIGH ST SUITE 202
WESTWOOD MA
02090-2539
US

IV. Provider business mailing address

805 HIGH ST SUITE 202
WESTWOOD MA
02090-2539
US

V. Phone/Fax

Practice location:
  • Phone: 781-326-1932
  • Fax: 781-326-6508
Mailing address:
  • Phone: 781-326-1932
  • Fax: 781-326-6508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14832
License Number StateMA

VIII. Authorized Official

Name: DR. FREDERICK JOSEPH INSOGNA
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 781-326-1932