Provider Demographics
NPI:1508879917
Name:D'ERAMO, EDWARD M (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:M
Last Name:D'ERAMO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 MALDEN STREET
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151
Mailing Address - Country:US
Mailing Address - Phone:781-284-3200
Mailing Address - Fax:781-284-3893
Practice Address - Street 1:69 MALDEN STREET
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151
Practice Address - Country:US
Practice Address - Phone:781-284-3200
Practice Address - Fax:781-284-3893
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110921223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA16341OtherHARVARD PILGRIM
MAX03788OtherBLUE CROSS
MAT57072Medicare ID - Type Unspecified