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General NPI Number Information
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NPI Number | 1285190744
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Entity Type | Individual
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Provider Name | PAOLO JUNIOR FANTOZZI D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 02/20/2019
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Last Update Date | 02/20/2019
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Provider Practice Location Address
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Address Line | 75 FRANCIS ST
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City | BOSTON
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State | MA
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Zip | 02115-6110
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Country | US
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Telephone | 617-732-6570
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Fax |
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Provider Business Mailing Address
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Address Line | 1620 TREMONT ST STE BC-3028
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City | BOSTON
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State | MA
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Zip | 02120-1613
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Country | US
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Telephone | 617-732-6570
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DL13898
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License Number State | MA
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