Provider Demographics
NPI:1578650420
Name:ALBANESE, DOMENIC (DMD)
Entity Type:Individual
Prefix:DR
First Name:DOMENIC
Middle Name:
Last Name:ALBANESE
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 1:65 FREMONT ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-1271
Mailing Address - Country:US
Mailing Address - Phone:508-460-8426
Mailing Address - Fax:508-460-8977
Practice Address - Street 1:65 FREMONT ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-1271
Practice Address - Country:US
Practice Address - Phone:508-460-8426
Practice Address - Fax:508-460-8977
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA165251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice