Provider Demographics
NPI:1710904545
Name:ANTHONY N GIAMBERARDINO DMD PC
Entity Type:Organization
Organization Name:ANTHONY N GIAMBERARDINO DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:N
Authorized Official - Last Name:GIAMBERARDINO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-396-3800
Mailing Address - Street 1:84 HIGH ST
Mailing Address - Street 2:#304
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155
Mailing Address - Country:US
Mailing Address - Phone:781-396-3800
Mailing Address - Fax:781-396-2337
Practice Address - Street 1:84 HIGH ST
Practice Address - Street 2:#304
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155
Practice Address - Country:US
Practice Address - Phone:781-396-3800
Practice Address - Fax:781-396-2337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA161211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty