Provider Demographics
NPI:1801009675
Name:BUCCINO, MICHAEL ANTHONY (DDS MSD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:BUCCINO
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1909
Mailing Address - Street 2:
Mailing Address - City:N FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02556
Mailing Address - Country:US
Mailing Address - Phone:508-676-0111
Mailing Address - Fax:508-678-6764
Practice Address - Street 1:497 ROBESON STREET
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720
Practice Address - Country:US
Practice Address - Phone:508-676-0111
Practice Address - Fax:508-678-6764
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA168091223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry