Provider Demographics
NPI:1578646980
Name:DOVIDIO, ANITA S (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:S
Last Name:DOVIDIO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:
Other - Last Name:BRAVERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:337 BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821
Mailing Address - Country:US
Mailing Address - Phone:978-663-3321
Mailing Address - Fax:978-667-6361
Practice Address - Street 1:337 BOSTON RD
Practice Address - Street 2:
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821
Practice Address - Country:US
Practice Address - Phone:978-663-3321
Practice Address - Fax:978-667-6361
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA169801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice