Provider Demographics
NPI:1700949385
Name:PHILIP A STRUZZIERO
Entity Type:Organization
Organization Name:PHILIP A STRUZZIERO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:A
Authorized Official - Last Name:STRUZZIERO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-356-8111
Mailing Address - Street 1:575 WASHINGTON ST
Mailing Address - Street 2:SUITE 152
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-5620
Mailing Address - Country:US
Mailing Address - Phone:781-356-8111
Mailing Address - Fax:781-356-9036
Practice Address - Street 1:575 WASHINGTON ST
Practice Address - Street 2:SUITE 152
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-5620
Practice Address - Country:US
Practice Address - Phone:781-356-8111
Practice Address - Fax:781-356-9036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN129181122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty