MEDICARE: FANTASIA, FAILLA, AND DEFRANCESCO FAMILY DENTISTRY

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
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1780091363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FANTASIA, FAILLA, AND DEFRANCESCO FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	293 MOUNT AUBURN ST
Second Line	:
City	:	WATERTOWN
State	:	MA
Zip	:	02472-1955
Country	:	US
Telephone Number	:	617-923-9446
Fax Number	:	617-923-4250

Provider Business Practice Location Address
First Line	:	293 MOUNT AUBURN ST
Second Line	:
City	:	WATERTOWN
State	:	MA
Zip	:	02472-1955
Country	:	US
Telephone Number	:	617-923-9446
Fax Number	:	617-923-4250

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. ROBERT DEFRANCESCO
Credential	:	D.M.D.
Telephone Number	:	781-894-3143

Provider Enumeration Date	:	07/16/2014
Last Update Date	:	07/16/2014

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Directions to “FANTASIA, FAILLA, AND DEFRANCESCO FAMILY DENTISTRY ” Practice Location

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