Provider Demographics
NPI:1205040656
Name:DIONNE, ERIC DARIUS (DDS)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:DARIUS
Last Name:DIONNE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:DARIUISH
Other - Middle Name:
Other - Last Name:AFZALI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:80 HOPE AVE
Mailing Address - Street 2:APT#518
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-2743
Mailing Address - Country:US
Mailing Address - Phone:617-378-8277
Mailing Address - Fax:
Practice Address - Street 1:255 PARK AVE
Practice Address - Street 2:SUITE #303
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1953
Practice Address - Country:US
Practice Address - Phone:508-755-3636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA195691223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics