Provider Demographics
NPI:1508055245
Name:LILIANA E. DIFABIO, DMD, PC
Entity Type:Organization
Organization Name:LILIANA E. DIFABIO, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LILIANA
Authorized Official - Middle Name:ESTHER
Authorized Official - Last Name:DIFABIO
Authorized Official - Suffix:II
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-569-0021
Mailing Address - Street 1:56 BENNINGTON ST
Mailing Address - Street 2:
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-1704
Mailing Address - Country:US
Mailing Address - Phone:617-567-2949
Mailing Address - Fax:
Practice Address - Street 1:56 BENNINGTON ST
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-1704
Practice Address - Country:US
Practice Address - Phone:617-567-2949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17685261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0273198Medicaid