Provider Demographics
NPI:1164573903
Name:JULIA O FAIGEL DMD PC
Entity Type:Organization
Organization Name:JULIA O FAIGEL DMD PC
Other - Org Name:MERIDIAN FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-567-1300
Mailing Address - Street 1:55 MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-1959
Mailing Address - Country:US
Mailing Address - Phone:617-567-1300
Mailing Address - Fax:
Practice Address - Street 1:55 MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-1959
Practice Address - Country:US
Practice Address - Phone:617-567-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0203980Medicaid