Provider Demographics
NPI:1336254994
Name:SLOCUM VASSALLO, LINDA MARIE (DMD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIE
Last Name:SLOCUM VASSALLO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WOODS ROAD
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061
Mailing Address - Country:US
Mailing Address - Phone:781-659-3303
Mailing Address - Fax:
Practice Address - Street 1:693 PLAIN STREET
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050
Practice Address - Country:US
Practice Address - Phone:781-837-1709
Practice Address - Fax:781-837-3481
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA185441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice