Provider Demographics
NPI:1093039687
Name:PAUL J DUFFELL DMD PC
Entity Type:Organization
Organization Name:PAUL J DUFFELL DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUFFELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD PC
Authorized Official - Phone:617-244-4133
Mailing Address - Street 1:456 NEWTONVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTONVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02460
Mailing Address - Country:US
Mailing Address - Phone:617-244-4133
Mailing Address - Fax:617-244-1408
Practice Address - Street 1:456 NEWTONVILLE AVE
Practice Address - Street 2:
Practice Address - City:NEWTONVILLE
Practice Address - State:MA
Practice Address - Zip Code:02460
Practice Address - Country:US
Practice Address - Phone:617-244-4133
Practice Address - Fax:617-244-1408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA14196122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty