Provider Demographics
NPI:1154586410
Name:PACZESNY, DIANA
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:PACZESNY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 POND AVE
Mailing Address - Street 2:APT 708
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7129
Mailing Address - Country:US
Mailing Address - Phone:617-935-1485
Mailing Address - Fax:
Practice Address - Street 1:99 POND AVE
Practice Address - Street 2:APT 708
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7129
Practice Address - Country:US
Practice Address - Phone:617-935-1485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA99781223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics