Provider Demographics
NPI:1235254681
Name:FUGAZZOTTO, PAUL ANTHONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ANTHONY
Last Name:FUGAZZOTTO
Suffix:
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 1:25 HIGH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3426
Mailing Address - Country:US
Mailing Address - Phone:671-696-7257
Mailing Address - Fax:617-696-6635
Practice Address - Street 1:25 HIGH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-3426
Practice Address - Country:US
Practice Address - Phone:671-696-7257
Practice Address - Fax:617-696-6635
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA144011223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX10364OtherBLUE CROSS & BLUE SHIELD
MAX31025OtherHARVARD PILGRIM HEALTH CA