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General NPI Number Information
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NPI Number | 1740667542
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Entity Type | Organization
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Legal Business Name | ROBERT A. FAIELLA, DMD, MMSC, PC
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Dates
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Enumeration Date | 04/30/2015
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Last Update Date | 04/30/2015
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Provider Practice Location Address
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Address Line | 749 MAIN ST SUITE B
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City | OSTERVILLE
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State | MA
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Zip | 02655-1944
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Country | US
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Telephone | 508-420-1124
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Fax | 508-420-0904
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Provider Business Mailing Address
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Address Line | 749 MAIN ST SUITE B
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City | OSTERVILLE
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State | MA
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Zip | 02655-1944
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Country | US
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Telephone | 508-420-1124
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Fax | 508-420-0904
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT A. FAIELLA
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Credential | D.M.D., M.M.SC.
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Telephone | 508-420-1124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 15238
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License Number State | MA
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