Provider Demographics
NPI:1184649444
Name:MARIANI, EUGENE J JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:J
Last Name:MARIANI
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 ELM ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2541
Mailing Address - Country:US
Mailing Address - Phone:508-754-1122
Mailing Address - Fax:508-754-9378
Practice Address - Street 1:48 ELM ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2541
Practice Address - Country:US
Practice Address - Phone:508-754-1122
Practice Address - Fax:508-754-9378
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA133611223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics