Provider Demographics
NPI:1457393951
Name:DRS. MANZOLI AND RUSSO, PC
Entity Type:Organization
Organization Name:DRS. MANZOLI AND RUSSO, PC
Other - Org Name:CENTRAL NEW ENGLAND ENDODONTICS & IMPLANTOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-791-5529
Mailing Address - Street 1:67 HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2734
Mailing Address - Country:US
Mailing Address - Phone:508-791-5529
Mailing Address - Fax:508-791-4546
Practice Address - Street 1:67 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2734
Practice Address - Country:US
Practice Address - Phone:508-791-5529
Practice Address - Fax:508-791-4546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA113551223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty