Provider Demographics
NPI:1104972181
Name:RICHARD LOGUERCIO DDS PC
Entity type:Organization
Organization Name:RICHARD LOGUERCIO DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGUERCIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:781-963-0860
Mailing Address - Street 1:56 SO MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368
Mailing Address - Country:US
Mailing Address - Phone:781-963-0860
Mailing Address - Fax:781-961-2445
Practice Address - Street 1:56 SO MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368
Practice Address - Country:US
Practice Address - Phone:781-963-0860
Practice Address - Fax:781-961-2445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA123721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty