Matthew R Fantasia, DMD Valid NPI
Individual provider · General Practice Dentistry · Wellesley, MA
- NPI
- 1376752840
- Type
- Individual (Type 1)
- Primary specialty
- General Practice Dentistry (Dentist)
- Specialty group
- Dental Providers
- Taxonomy code
- 1223G0001X
- License number
- 20441 (MA)
- Sex
- Male
- Sole proprietor
- No
- Enumerated
- 2007-05-22
- Last updated
- 2007-07-08
Practice location
372 Washington St
Wellesley, MA 02481
(781) 235-1146