Provider Demographics
NPI:1750491825
Name:SCOPPETTUOLO, EDWARD WILLIAM JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:WILLIAM
Last Name:SCOPPETTUOLO
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 ADAMS ST
Mailing Address - Street 2:STE 202
Mailing Address - City:ABINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02351
Mailing Address - Country:US
Mailing Address - Phone:781-871-1949
Mailing Address - Fax:781-871-1459
Practice Address - Street 1:313 ADAMS ST
Practice Address - Street 2:STE 202
Practice Address - City:ABINGTON
Practice Address - State:MA
Practice Address - Zip Code:02351
Practice Address - Country:US
Practice Address - Phone:781-871-1949
Practice Address - Fax:781-871-1459
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA123951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice