Provider Demographics
NPI:1376701094
Name:GIARRUSSO, FREDERICK JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:JOSEPH
Last Name:GIARRUSSO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:27 MECHANICS ST
Mailing Address - Street 2:203
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-2408
Mailing Address - Country:US
Mailing Address - Phone:508-753-2489
Mailing Address - Fax:508-795-3892
Practice Address - Street 1:27 MECHANICS ST
Practice Address - Street 2:203
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-2408
Practice Address - Country:US
Practice Address - Phone:508-753-2489
Practice Address - Fax:508-795-3892
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA102291223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics