MEDICARE: DR. DANIEL CARMINE VARALLO DMD

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	18807	MA

General Provider Information

NPI Number	:	1881766582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL CARMINE VARALLO DMD

Provider Business Mailing Address
First Line	:	800 MASSACHUSETTS AVE STE 1
Second Line	:
City	:	ARLINGTON
State	:	MA
Zip	:	02476-4736
Country	:	US
Telephone Number	:	781-648-9200
Fax Number	:	781-648-9201

Provider Business Practice Location Address
First Line	:	800 MASSACHUSETTS AVE STE 1
Second Line	:
City	:	ARLINGTON
State	:	MA
Zip	:	02476-4736
Country	:	US
Telephone Number	:	781-648-9200
Fax Number	:	781-648-9201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	07/08/2007

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