Provider Demographics
NPI:1427433168
Name:TESORIERO, JOHN ROSS
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROSS
Last Name:TESORIERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 SQUIRE RD
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-1314
Mailing Address - Country:US
Mailing Address - Phone:781-289-8080
Mailing Address - Fax:
Practice Address - Street 1:50 SQUIRE RD
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-1314
Practice Address - Country:US
Practice Address - Phone:781-289-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856988122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist