Provider Demographics
NPI:1215941323
Name:VOSCHIN, MICHAEL N (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:N
Last Name:VOSCHIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 WASHINGTON ST
Mailing Address - Street 2:OAK SQUARE
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-1606
Mailing Address - Country:US
Mailing Address - Phone:617-782-5030
Mailing Address - Fax:617-782-8550
Practice Address - Street 1:637 WASHINGTON ST
Practice Address - Street 2:OAK SQUARE
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-1606
Practice Address - Country:US
Practice Address - Phone:617-782-5030
Practice Address - Fax:617-782-8550
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA193831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0282006Medicaid