Healthcare Provider Details

I. General information

NPI: 1881878403
Provider Name (Legal Business Name): EUGENE J. MARIANI, JR., D.D.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 ELM ST
WORCESTER MA
01609-2541
US

IV. Provider business mailing address

48 ELM ST
WORCESTER MA
01609-2541
US

V. Phone/Fax

Practice location:
  • Phone: 508-754-1122
  • Fax: 508-754-9378
Mailing address:
  • Phone: 508-754-1122
  • Fax: 508-754-9378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number13361
License Number StateMA

VIII. Authorized Official

Name: DR. EUGENE J MARIANI JR.
Title or Position: PERIODONTIST
Credential: DDS
Phone: 508-754-1122