Provider Demographics
NPI:1609994920
Name:CASTELLUCCI, GIOVANNI (DMD)
Entity Type:Individual
Prefix:DR
First Name:GIOVANNI
Middle Name:
Last Name:CASTELLUCCI
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 1:661 FRANKLIN STREET
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-2900
Mailing Address - Country:US
Mailing Address - Phone:508-875-6185
Mailing Address - Fax:508-872-5745
Practice Address - Street 1:661 FRANKLIN STREET
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-2900
Practice Address - Country:US
Practice Address - Phone:508-875-6185
Practice Address - Fax:508-872-5745
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159831223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
0239OtherDELTA DENTAL