Provider Demographics
NPI:1578767570
Name:CANESI, JOHN E (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:CANESI
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 1:21 MERCHANTS ROW
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109
Mailing Address - Country:US
Mailing Address - Phone:617-523-0688
Mailing Address - Fax:617-557-4140
Practice Address - Street 1:21 MERCHANTS ROW
Practice Address - Street 2:SUITE 2A
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109
Practice Address - Country:US
Practice Address - Phone:617-523-0688
Practice Address - Fax:617-557-4140
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA139021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice