Paul Anthony Fugazzotto, D.D.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

14401 Issued in MA

Practice address

25 High St
Suite 103
Milton, MA 02186-3426

Phone

(671) 696-7257

Fax

(617) 696-6635

NPI assigned

Mar 21, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Paul a. Fugazzotto,DDS, PC

  • Dentist
  • Milton, MA
  • NPI 1073867529
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1235254681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 HIGH ST",
            "address_2": "SUITE 103",
            "city": "MILTON",
            "state": "MA",
            "postal_code": "021863426",
            "telephone_number": "671-696-7257",
            "fax_number": "617-696-6635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 HIGH ST",
            "address_2": "SUITE 103",
            "city": "MILTON",
            "state": "MA",
            "postal_code": "021863426",
            "telephone_number": "671-696-7257",
            "fax_number": "617-696-6635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUGAZZOTTO",
        "first_name": "PAUL",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "MA",
            "license": "14401",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "X10364",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM HEALTH CA",
            "identifier": "X31025",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paul Fleury, ATC
• Richard G. Florentine, MD
• Jade Fortes
• Franci a. Richardson, Licsw, LLC
• Tanya Judith Frank, LICSW
• Melissa Fullam, RD, IBCLC
• Russell Fullerton, MD
• Wing Kin Fung, M.D.
• Julianne Funtsch
• Christopher Gallant, LICSW

• Periodontics in Milton, MA
• Providers in Milton, MA by specialty
• Periodontics in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.