Provider Demographics
NPI:1770641318
Name:STUPARICH, MAURO ANTONIO (DMD CAGS)
Entity Type:Individual
Prefix:MR
First Name:MAURO
Middle Name:ANTONIO
Last Name:STUPARICH
Suffix:
Gender:M
Credentials:DMD CAGS
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Mailing Address - Street 1:321 COLUMBUS AVE
Mailing Address - Street 2:SUITE 1R
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116
Mailing Address - Country:US
Mailing Address - Phone:617-437-6800
Mailing Address - Fax:617-437-1900
Practice Address - Street 1:321 COLUMBUS AVE
Practice Address - Street 2:SUITE 1R
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116
Practice Address - Country:US
Practice Address - Phone:617-437-6800
Practice Address - Fax:617-437-1900
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA183131223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics