Provider Demographics
NPI:1891835609
Name:DIPIETRO FAMILY DENTAL CARE, INC.
Entity Type:Organization
Organization Name:DIPIETRO FAMILY DENTAL CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:DIPIETRO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-284-6826
Mailing Address - Street 1:123 REVERE ST
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-4439
Mailing Address - Country:US
Mailing Address - Phone:781-284-6826
Mailing Address - Fax:781-284-1171
Practice Address - Street 1:123 REVERE ST
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-4439
Practice Address - Country:US
Practice Address - Phone:781-284-6826
Practice Address - Fax:781-284-1171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA148131223G0001X
MA170301223G0001X
MA184041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty