Provider Demographics
NPI:1134391634
Name:RICHARD NUTILE DDS INC
Entity type:Organization
Organization Name:RICHARD NUTILE DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:NUTILE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:781-245-6966
Mailing Address - Street 1:725 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-5206
Mailing Address - Country:US
Mailing Address - Phone:781-245-6966
Mailing Address - Fax:781-245-7403
Practice Address - Street 1:725 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-5206
Practice Address - Country:US
Practice Address - Phone:781-245-6966
Practice Address - Fax:781-245-7403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9424122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty