Provider Demographics
NPI:1891910568
Name:FAIELLA, ROBERT A (DMD, MMSC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:FAIELLA
Suffix:
Gender:M
Credentials:DMD, MMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:749 MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:OSTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02655-1944
Mailing Address - Country:US
Mailing Address - Phone:508-420-1124
Mailing Address - Fax:508-420-0904
Practice Address - Street 1:749 MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:OSTERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02655-1944
Practice Address - Country:US
Practice Address - Phone:508-420-1124
Practice Address - Fax:508-420-0904
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152381223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics