Individual
PAUL EDWARD TESONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
563 BROADWAY, #4, EVERETT, MA 02149
(617) 389-4950
(617) 389-8604
Mailing address
563 BROADWAY, STE 4, EVERETT, MA 02149-3749
(617) 389-4950
(617) 389-8604
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
11620
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0230111
—
MA
05
—
0280011
—
MA
01
—
X11108
BCBSMA#1
MA
01
—
X11109
BCBSMA#2
MA
Enumeration date
01/24/2007
Last updated
04/22/2016
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