Provider Demographics
NPI:1881665636
Name:BOCCIA, THOMAS EDWIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EDWIN
Last Name:BOCCIA
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:PO BOX 244
Mailing Address - Street 2:
Mailing Address - City:STURBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01566-0244
Mailing Address - Country:US
Mailing Address - Phone:508-347-9336
Mailing Address - Fax:508-347-5072
Practice Address - Street 1:3 WALLACE RD
Practice Address - Street 2:
Practice Address - City:STURBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01566-1425
Practice Address - Country:US
Practice Address - Phone:508-347-9336
Practice Address - Fax:508-347-5072
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA105591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice