Provider Demographics
NPI:1275550220
Name:DITOMASSI, GEORGE ROBERT III (DDS)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:ROBERT
Last Name:DITOMASSI
Suffix:III
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 1:1795 MAIN STREET
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-1077
Mailing Address - Country:US
Mailing Address - Phone:413-733-6576
Mailing Address - Fax:413-731-8655
Practice Address - Street 1:1795 MAIN STREET
Practice Address - Street 2:SUITE 206
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1077
Practice Address - Country:US
Practice Address - Phone:413-733-6576
Practice Address - Fax:413-731-8655
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23130-8751223G0001X
MA168051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice