Provider Demographics
NPI:1992154702
Name:BOSCHETTI, NICHOLAS MICHAEL (DMD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:MICHAEL
Last Name:BOSCHETTI
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 1:869 BEACON ST
Mailing Address - Street 2:APARTMENT 5
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-3846
Mailing Address - Country:US
Mailing Address - Phone:781-439-4481
Mailing Address - Fax:
Practice Address - Street 1:1 ORR SQ
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-3200
Practice Address - Country:US
Practice Address - Phone:781-284-1430
Practice Address - Fax:781-284-5422
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18572471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice