Provider Demographics
NPI:1104956705
Name:ANSELLO, DAWN ANDREA (DMD)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:ANDREA
Last Name:ANSELLO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 CABOT ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-2511
Mailing Address - Country:US
Mailing Address - Phone:978-927-7250
Mailing Address - Fax:978-927-7441
Practice Address - Street 1:550 CABOT ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-2511
Practice Address - Country:US
Practice Address - Phone:978-927-7250
Practice Address - Fax:978-927-7441
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204651223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery