Provider Demographics
NPI:1801112966
Name:WILLIAM F DAGILIS DMD PC
Entity type:Organization
Organization Name:WILLIAM F DAGILIS DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:DAGILIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-753-5488
Mailing Address - Street 1:928 GRAFTON ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-2006
Mailing Address - Country:US
Mailing Address - Phone:508-753-5488
Mailing Address - Fax:508-792-0995
Practice Address - Street 1:928 GRAFTON ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-2006
Practice Address - Country:US
Practice Address - Phone:508-753-5488
Practice Address - Fax:508-792-0995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADM13455-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty