Provider Demographics
NPI:1932437936
Name:BELMONT FAMILY DENTISTRY
Entity Type:Organization
Organization Name:BELMONT FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FICALORA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:617-484-1760
Mailing Address - Street 1:75 TRAPELO RD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-4448
Mailing Address - Country:US
Mailing Address - Phone:617-484-1796
Mailing Address - Fax:617-484-4130
Practice Address - Street 1:75 TRAPELO RD
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-4448
Practice Address - Country:US
Practice Address - Phone:617-484-1796
Practice Address - Fax:617-484-4130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA174821223G0001X
MA202921223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty