Provider Demographics
NPI:1881648889
Name:DELCUPOLO, MARY ANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY ANNE
Middle Name:
Last Name:DELCUPOLO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 FRANKLIN ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169
Mailing Address - Country:US
Mailing Address - Phone:617-773-4446
Mailing Address - Fax:617-773-6431
Practice Address - Street 1:21 FRANKLIN ST
Practice Address - Street 2:SUITE #1
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169
Practice Address - Country:US
Practice Address - Phone:617-773-4446
Practice Address - Fax:617-773-6431
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13641122300000X
RI02010122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist