Provider Demographics
NPI:1881766582
Name:VARALLO, DANIEL CARMINE (DMD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:CARMINE
Last Name:VARALLO
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 1:800 MASSACHUSETTS AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-4736
Mailing Address - Country:US
Mailing Address - Phone:781-648-9200
Mailing Address - Fax:781-648-9201
Practice Address - Street 1:800 MASSACHUSETTS AVE STE 1
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-4736
Practice Address - Country:US
Practice Address - Phone:781-648-9200
Practice Address - Fax:781-648-9201
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA188071223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics