Individual
MISS AMY B FANTONI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
670 W BOYLSTON ST, WORCESTER, MA 01606-2064
(508) 854-7548
Mailing address
670 W BOYLSTON ST, WORCESTER, MA 01606-2064
(508) 854-7548
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
8559
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1301071
MEDICAID GROUP #
MA
Enumeration date
12/30/2008
Last updated
12/30/2008
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