Provider Demographics
NPI:1659402899
Name:MARY ANNE DELCUPOLO DDS PC
Entity Type:Organization
Organization Name:MARY ANNE DELCUPOLO DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DELCUPOLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:508-678-9047
Mailing Address - Street 1:H2 SWANSEA MALL
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777
Mailing Address - Country:US
Mailing Address - Phone:508-678-9047
Mailing Address - Fax:508-678-9220
Practice Address - Street 1:H2 SWANSEA MALL
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777
Practice Address - Country:US
Practice Address - Phone:508-678-9047
Practice Address - Fax:508-678-9220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA136411223G0001X
MA110231223P0300X
MA131641223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX04643Medicare ID - Type Unspecified