Provider Demographics
NPI:1780740035
Name:SANDRA TRANTAGLIA DMD PC
Entity type:Organization
Organization Name:SANDRA TRANTAGLIA DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRANFAGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-628-2006
Mailing Address - Street 1:17 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-4401
Mailing Address - Country:US
Mailing Address - Phone:617-628-2006
Mailing Address - Fax:617-628-2007
Practice Address - Street 1:17 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-4401
Practice Address - Country:US
Practice Address - Phone:617-628-2006
Practice Address - Fax:617-628-2007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19406122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty