Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | 12656 | MA |
N | 1223P0221X | Pediatric Dentist | 12656 | MA |
N | 1223P0300X | Periodontist | 12656 | MA |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 12656 | MA |
N | 1223X0400X | Orthodontists | 12656 | MA |
NPI | 1013131895 |
---|---|
Provider Name | Dr. Hugo P Dambrosio JR. |
First Address | Falmouth, MA 02540 |
Second Address | Falmouth, MA 02540 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2007 |
Last Update Date | 08/07/2007 |