Provider Demographics
NPI:1790898120
Name:MOSCHELLA, WILLIAM A (DMD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:MOSCHELLA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-2340
Mailing Address - Country:US
Mailing Address - Phone:781-233-2450
Mailing Address - Fax:781-231-1873
Practice Address - Street 1:20 MAIN ST
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-2340
Practice Address - Country:US
Practice Address - Phone:781-233-2450
Practice Address - Fax:781-231-1873
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA142001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice