Provider Demographics
NPI:1972760510
Name:MASSABNI, EDMOND (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDMOND
Middle Name:
Last Name:MASSABNI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 MAIN ST
Mailing Address - Street 2:#116
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-2502
Mailing Address - Country:US
Mailing Address - Phone:508-478-1555
Mailing Address - Fax:508-475-7105
Practice Address - Street 1:208 MAIN ST
Practice Address - Street 2:#116
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2502
Practice Address - Country:US
Practice Address - Phone:508-478-1555
Practice Address - Fax:508-478-7105
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA206941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice