Individual
DR. PHILIP DOMINIC FANTASIA JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
293 MOUNT AUBURN ST, WATERTOWN, MA 02472-1955
(617) 923-9446
(617) 923-4250
Mailing address
293 MOUNT AUBURN ST, WATERTOWN, MA 02472-1955
(617) 923-9446
(617) 923-4250
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
11934
MA
Other
Enumeration date
08/24/2006
Last updated
07/08/2007
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