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Organization

PHILIP D FANTASIA JR DDS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. PHILIP DOMENIC FANTASIA JR. DDS (DENTIST)
(617) 923-9446
Entity
Organization

Contact information

Practice address
293 MOUNT AUBURN ST, WATERTOWN, MA 02472-1955
(617) 923-9446
(617) 923-4750
Mailing address
293 MOUNT AUBURN ST, WATERTOWN, MA 02472-1955
(617) 923-9446
(617) 923-4750

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
11934
MA

Other

Enumeration date
08/30/2007
Last updated
08/30/2007
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