Provider Demographics
NPI:1942347331
Name:PETER M FRASCA D.M.D, P.C.
Entity Type:Organization
Organization Name:PETER M FRASCA D.M.D, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:M
Authorized Official - Last Name:FRASCA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-927-3966
Mailing Address - Street 1:109 DODGE ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-1053
Mailing Address - Country:US
Mailing Address - Phone:978-927-3966
Mailing Address - Fax:978-921-9171
Practice Address - Street 1:109 DODGE ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1053
Practice Address - Country:US
Practice Address - Phone:978-927-3966
Practice Address - Fax:978-921-9171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA129721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty