Provider Demographics
NPI:1114190139
Name:FREDERICK J. INSOGNA, D.M.D.,P.C.
Entity Type:Organization
Organization Name:FREDERICK J. INSOGNA, D.M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:INSOGNA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-326-1932
Mailing Address - Street 1:805 HIGH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-2539
Mailing Address - Country:US
Mailing Address - Phone:781-326-1932
Mailing Address - Fax:781-326-6508
Practice Address - Street 1:805 HIGH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-2539
Practice Address - Country:US
Practice Address - Phone:781-326-1932
Practice Address - Fax:781-326-6508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA148321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1285712794OtherADD'L NPI NO.