Provider Demographics
NPI:1811316193
Name:ANDERSON, GRACE E (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:E
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:E
Other - Last Name:GIANNESCHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD, MS
Mailing Address - Street 1:10 CHARLESGATE E APT 102
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-2368
Mailing Address - Country:US
Mailing Address - Phone:614-218-0015
Mailing Address - Fax:
Practice Address - Street 1:223 CHIEF JUSTICE CUSHING HWY STE 102
Practice Address - Street 2:
Practice Address - City:COHASSET
Practice Address - State:MA
Practice Address - Zip Code:02025-1391
Practice Address - Country:US
Practice Address - Phone:781-383-0003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18575301223P0221X
MADN1857530122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program