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NPI Code Detail

MEDICARE: DR. MATTHEW R ANNESE D.M.D

MEDICARE: DR. MATTHEW R ANNESE D.M.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistDN1856006MA

General Provider Information

NPI Number : 1114289246
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MATTHEW R ANNESE D.M.D
Provider Business Mailing Address
First Line : 111 WILLOW AVE
Second Line : APT 1
City : SOMERVILLE
State : MA
Zip : 02144-2527
Country : US
Telephone Number : 978-804-3641
Fax Number :
Provider Business Practice Location Address
First Line : 637 WASHINGTON ST
Second Line : DENTAL DEPARTMENT
City : BOSTON
State : MA
Zip : 02124-3510
Country : US
Telephone Number : 617-822-4747
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2012
Last Update Date : 08/12/2014

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