Provider Demographics
NPI:1528126760
Name:ANITA KARASKO DMD PC
Entity type:Organization
Organization Name:ANITA KARASKO DMD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:KARASKO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-543-7755
Mailing Address - Street 1:26 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-1807
Mailing Address - Country:US
Mailing Address - Phone:508-543-7755
Mailing Address - Fax:508-543-7788
Practice Address - Street 1:26 MAIN ST
Practice Address - Street 2:
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-1807
Practice Address - Country:US
Practice Address - Phone:508-543-7755
Practice Address - Fax:508-543-7788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207991223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX12203OtherBCBS
MA0208680Medicaid
MA1789437OtherUNITED CONCORDIA