Provider Demographics
NPI:1568575405
Name:DRS. MANZOLI & RUSSO, PC
Entity Type:Organization
Organization Name:DRS. MANZOLI & RUSSO, PC
Other - Org Name:CENTRAL NEW ENGLAND ENDODONTICS & IMPLANTOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-791-5529
Mailing Address - Street 1:39 KENNEDY DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1939
Mailing Address - Country:US
Mailing Address - Phone:860-928-9115
Mailing Address - Fax:860-928-5821
Practice Address - Street 1:39 KENNEDY DR
Practice Address - Street 2:SUITE C
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1939
Practice Address - Country:US
Practice Address - Phone:860-928-9115
Practice Address - Fax:860-928-5821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty