Provider Demographics
NPI:1912358250
Name:DENIETOLIS, MARIA (OD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:DENIETOLIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-2443
Mailing Address - Country:US
Mailing Address - Phone:508-226-3330
Mailing Address - Fax:
Practice Address - Street 1:160 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2443
Practice Address - Country:US
Practice Address - Phone:508-226-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5143152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist