Organization
MATTHEW R. FANTASIA, D.M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW R. FANTASIA D.M.D. (PRESIDENT)
(781) 235-1146
Entity
Organization
Contact information
Practice address
372 WASHINGTON ST, WELLESLEY, MA 02481-6202
(781) 235-1146
(781) 235-9195
Mailing address
372 WASHINGTON ST, WELLESLEY, MA 02481-6202
(781) 235-1146
(781) 235-9195
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN 20441
MA
1223P0700X
Prosthodontics
DN 14506
MA
Other
Enumeration date
10/01/2012
Last updated
10/15/2012
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