Provider Demographics
NPI:1265653471
Name:FACELLA, FRANK A (DDS)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:A
Last Name:FACELLA
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 1:1671 WORCESTER ROAD
Mailing Address - Street 2:STE 401
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701
Mailing Address - Country:US
Mailing Address - Phone:508-872-3598
Mailing Address - Fax:508-872-0931
Practice Address - Street 1:1671 WORCESTER ROAD
Practice Address - Street 2:STE 401 DANFORTH DENTAL PC
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701
Practice Address - Country:US
Practice Address - Phone:508-872-3598
Practice Address - Fax:508-872-0931
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA148331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA14833OtherDENTAL