Provider Demographics
NPI:1053587592
Name:MASCIA, PHILIP RALPH (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:RALPH
Last Name:MASCIA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 FEDERAL RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-2406
Mailing Address - Country:US
Mailing Address - Phone:203-775-3344
Mailing Address - Fax:203-775-1328
Practice Address - Street 1:360 FEDERAL RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2426
Practice Address - Country:US
Practice Address - Phone:203-775-3344
Practice Address - Fax:203-775-1328
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0091051223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics