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NPI Code Detail

MEDICARE: JACOB BOMMARITO

MEDICARE: JACOB BOMMARITO
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
1122300000XDentistDN0000MA

General Provider Information

NPI Number : 1245185792
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB BOMMARITO
Provider Business Mailing Address
First Line : 300 LONGWOOD AVE
Second Line :
City : BOSTON
State : MA
Zip : 02115-5724
Country : US
Telephone Number : 617-355-6000
Fax Number :
Provider Business Practice Location Address
First Line : 300 LONGWOOD AVE
Second Line :
City : BOSTON
State : MA
Zip : 02115-5724
Country : US
Telephone Number : 617-355-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2026
Last Update Date : 03/02/2026

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Directions to “ JACOB BOMMARITO ” Practice Location

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