Provider Demographics
NPI:1235259417
Name:KASPARIAN FEDERICO, JOY ELIZABETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOY
Middle Name:ELIZABETH
Last Name:KASPARIAN FEDERICO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:ELIZABETH
Other - Last Name:KASPARIAN FEDERICO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:80 HIGH STREET
Mailing Address - Street 2:SUITE #2
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155
Mailing Address - Country:US
Mailing Address - Phone:781-396-9230
Mailing Address - Fax:781-391-6090
Practice Address - Street 1:80 HIGH STREET
Practice Address - Street 2:SUITE #2
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155
Practice Address - Country:US
Practice Address - Phone:781-396-9230
Practice Address - Fax:781-391-6090
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA192341223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0207021Medicaid