Provider Demographics
NPI:1033257571
Name:COGLIANO, PAUL ROBERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ROBERT
Last Name:COGLIANO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 ATLANTIC AVE
Mailing Address - Street 2:MERCANTILE WHARF BUILDING
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110-3702
Mailing Address - Country:US
Mailing Address - Phone:617-742-5560
Mailing Address - Fax:617-742-5562
Practice Address - Street 1:105 ATLANTIC AVE
Practice Address - Street 2:MERCANTILE WHARF BUILDING
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-3702
Practice Address - Country:US
Practice Address - Phone:617-742-5560
Practice Address - Fax:617-742-5562
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA133791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice