Provider Demographics
NPI:1396958195
Name:BOSCHETTI, ANTHONY M (DMD)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:M
Last Name:BOSCHETTI
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:PO BOX 527
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19607-0527
Mailing Address - Country:US
Mailing Address - Phone:413-739-1100
Mailing Address - Fax:413-737-3608
Practice Address - Street 1:532 SUMNER AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01108-2458
Practice Address - Country:US
Practice Address - Phone:413-739-1100
Practice Address - Fax:413-737-3608
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14919122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9185028OtherDORAL DENTAL PROVIDER ID
MA1310097Medicaid