Provider Demographics
NPI:1134331937
Name:MARY ANNE DEL COPOLO DDS PC
Entity Type:Organization
Organization Name:MARY ANNE DEL COPOLO DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL COPOLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:617-773-4446
Mailing Address - Street 1:21 FRANKLIN ST
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169
Mailing Address - Country:US
Mailing Address - Phone:617-773-4446
Mailing Address - Fax:617-773-6431
Practice Address - Street 1:21 FRANKLIN ST
Practice Address - Street 2:SUITE # 1
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169
Practice Address - Country:US
Practice Address - Phone:617-773-4446
Practice Address - Fax:617-773-6431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA136411223G0001X
RI20101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty