Provider Demographics
NPI:1740393685
Name:DRS. MANZOLI & RUSSO, P.C.
Entity Type:Organization
Organization Name:DRS. MANZOLI & RUSSO, P.C.
Other - Org Name:CENTRAL NEW ENGLAND ENDODONTICS & IMPLANTOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-791-5529
Mailing Address - Street 1:100 WHALON ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-7162
Mailing Address - Country:US
Mailing Address - Phone:978-345-7555
Mailing Address - Fax:978-348-2612
Practice Address - Street 1:100 WHALON ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-7162
Practice Address - Country:US
Practice Address - Phone:978-345-7555
Practice Address - Fax:978-348-2612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA113551223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty