Provider Demographics
NPI:1114114980
Name:GASSIRARO, L. DAVID (DMD)
Entity Type:Individual
Prefix:DR
First Name:L.
Middle Name:DAVID
Last Name:GASSIRARO
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 1:725 V.F.W. PARKWAY
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-1747
Mailing Address - Country:US
Mailing Address - Phone:617-323-2796
Mailing Address - Fax:617-323-3462
Practice Address - Street 1:725 VFW PKWY
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-1747
Practice Address - Country:US
Practice Address - Phone:617-323-2796
Practice Address - Fax:617-323-3462
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA177791223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics