Provider Demographics
NPI:1669435665
Name:MAMOLITO, PHILIP F (DMD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:F
Last Name:MAMOLITO
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 1:114 WENDELL AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-6976
Mailing Address - Country:US
Mailing Address - Phone:413-442-8684
Mailing Address - Fax:413-443-3275
Practice Address - Street 1:114 WENDELL AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-6976
Practice Address - Country:US
Practice Address - Phone:413-442-8684
Practice Address - Fax:413-443-3275
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA128511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA593804OtherBCBS
MA593804OtherDELTA DENTAL