Provider Demographics
NPI:1053402008
Name:KRISTINE A GRAZIOSO DMD PC
Entity type:Organization
Organization Name:KRISTINE A GRAZIOSO DMD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRAZIOSO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-383-0003
Mailing Address - Street 1:223 ROUTE 3A
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COHASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02025
Mailing Address - Country:US
Mailing Address - Phone:781-383-0003
Mailing Address - Fax:781-383-0032
Practice Address - Street 1:223 ROUTE 3A
Practice Address - Street 2:SUITE 102
Practice Address - City:COHASSET
Practice Address - State:MA
Practice Address - Zip Code:02025
Practice Address - Country:US
Practice Address - Phone:781-383-0003
Practice Address - Fax:781-383-0032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAD189351223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty