Provider Demographics
NPI:1114004165
Name:TSAGAS, JOANNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:
Last Name:TSAGAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 BRACKETT ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2511
Mailing Address - Country:US
Mailing Address - Phone:617-782-2848
Mailing Address - Fax:
Practice Address - Street 1:1096 REVERE BEACH PKWY
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-1454
Practice Address - Country:US
Practice Address - Phone:617-889-2090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice