Provider Demographics
NPI:1003895269
Name:ANGELINI, DOMENIC NICHOLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOMENIC
Middle Name:NICHOLAS
Last Name:ANGELINI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 ELM ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5414
Mailing Address - Country:US
Mailing Address - Phone:617-472-7910
Mailing Address - Fax:617-472-6058
Practice Address - Street 1:79 ELM ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5414
Practice Address - Country:US
Practice Address - Phone:617-472-7910
Practice Address - Fax:617-472-6058
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA148411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice