Provider Demographics
NPI:1265600829
Name:SACRAMONE, FREDERICK JOSEPH JR (DMD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:JOSEPH
Last Name:SACRAMONE
Suffix:JR
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 1:369 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:NEWTONVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1945
Mailing Address - Country:US
Mailing Address - Phone:617-244-3627
Mailing Address - Fax:
Practice Address - Street 1:369 WALNUT ST
Practice Address - Street 2:
Practice Address - City:NEWTONVILLE
Practice Address - State:MA
Practice Address - Zip Code:02460-1945
Practice Address - Country:US
Practice Address - Phone:617-244-3627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA161971223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics