Provider Demographics
NPI:1972648343
Name:GIDDON, DONALD B (DMD, PHD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:B
Last Name:GIDDON
Suffix:
Gender:M
Credentials:DMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 LINDEN ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-5900
Mailing Address - Country:US
Mailing Address - Phone:781-235-2995
Mailing Address - Fax:781-235-2996
Practice Address - Street 1:277 LINDEN ST
Practice Address - Street 2:SUITE 208
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-5900
Practice Address - Country:US
Practice Address - Phone:781-235-2995
Practice Address - Fax:781-235-2996
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1266103T00000X
MA9203122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R44246Medicare UPIN