Provider Demographics
NPI:1568636041
Name:RICHARD J. MCNULTY,D.M.D.,P.C.
Entity type:Organization
Organization Name:RICHARD J. MCNULTY,D.M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MCNULTY
Authorized Official - Suffix:SR
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-263-9900
Mailing Address - Street 1:310 WASHINGTON ST STE 208
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-4949
Mailing Address - Country:US
Mailing Address - Phone:781-263-9900
Mailing Address - Fax:
Practice Address - Street 1:310 WASHINTON ST.
Practice Address - Street 2:#208
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-0000
Practice Address - Country:US
Practice Address - Phone:781-263-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14347122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty