Provider Demographics
NPI:1073781787
Name:DR. RALPH LAURETANO SR.
Entity Type:Organization
Organization Name:DR. RALPH LAURETANO SR.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAURETANO
Authorized Official - Suffix:SR
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-729-7286
Mailing Address - Street 1:47 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-2829
Mailing Address - Country:US
Mailing Address - Phone:781-729-7286
Mailing Address - Fax:781-729-7287
Practice Address - Street 1:47 SHORE RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-2829
Practice Address - Country:US
Practice Address - Phone:781-729-7286
Practice Address - Fax:781-729-7287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA94941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty