Provider Demographics
NPI:1184704629
Name:MCNULTY, RICHARD J (DMD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:MCNULTY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 WASHINGTON ST
Mailing Address - Street 2:SUITE #208
Mailing Address - City:WELLESLEY HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02481-4949
Mailing Address - Country:US
Mailing Address - Phone:781-263-9900
Mailing Address - Fax:781-263-9903
Practice Address - Street 1:310 WASHINGTON ST
Practice Address - Street 2:SUITE #208
Practice Address - City:WELLESLEY HILLS
Practice Address - State:MA
Practice Address - Zip Code:02481-4949
Practice Address - Country:US
Practice Address - Phone:781-263-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA143471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice