Provider Demographics
NPI:1699942730
Name:DAMIAN D MEOLA DMD PC
Entity type:Organization
Organization Name:DAMIAN D MEOLA DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMIAN
Authorized Official - Middle Name:DONCITO
Authorized Official - Last Name:MEOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-893-7500
Mailing Address - Street 1:131 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453
Mailing Address - Country:US
Mailing Address - Phone:781-893-7500
Mailing Address - Fax:781-893-9090
Practice Address - Street 1:131 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453
Practice Address - Country:US
Practice Address - Phone:781-893-7500
Practice Address - Fax:781-893-9090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA175111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty