Provider Demographics
NPI:1710960612
Name:STRACQUALURSI, ROY J (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:J
Last Name:STRACQUALURSI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:ROY
Other - Middle Name:J
Other - Last Name:STRAC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:649 WALPOLE ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-2419
Mailing Address - Country:US
Mailing Address - Phone:781-769-1119
Mailing Address - Fax:781-769-1119
Practice Address - Street 1:649 WALPOLE ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-2419
Practice Address - Country:US
Practice Address - Phone:781-769-1119
Practice Address - Fax:781-769-1119
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15176122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0261971Medicaid