Provider Demographics
NPI:1922214204
Name:FAILLA & DEFRANCESCO FAMILY DENTISTRY, LLC
Entity Type:Organization
Organization Name:FAILLA & DEFRANCESCO FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DEFRANCESCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-894-3143
Mailing Address - Street 1:976 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-7413
Mailing Address - Country:US
Mailing Address - Phone:781-894-3143
Mailing Address - Fax:781-736-0712
Practice Address - Street 1:976 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-7413
Practice Address - Country:US
Practice Address - Phone:781-894-3143
Practice Address - Fax:781-736-0712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18231122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty