Provider Demographics
NPI:1477024552
Name:COGLIANO DENTAL
Entity Type:Organization
Organization Name:COGLIANO DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:COGLIANO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-742-5560
Mailing Address - Street 1:105 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110-3702
Mailing Address - Country:US
Mailing Address - Phone:617-742-5560
Mailing Address - Fax:617-742-5562
Practice Address - Street 1:105 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-3702
Practice Address - Country:US
Practice Address - Phone:617-742-5560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty