NPIMap

Organization Active NPI

Philip D Fantasia Jr DDS

  • General Practice Dentistry
  • Watertown, MA
National Provider Identifier
1518151760
Registry record updated Aug 30, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
11934 Issued in MA
Legal business name
PHILIP D FANTASIA JR DDS
Practice address
293 Mount Auburn St
Watertown, MA 02472-1955
Phone
(617) 923-9446
Fax
(617) 923-4750
NPI assigned
Aug 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2007

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

Authorized official

Name
Dr. Philip Domenic Fantasia Jr., DDSNPI 1871600023
Title
Dentist
Phone
(617) 923-9446

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 11934 MA Primary

Addresses

Primary practice location

293 Mount Auburn St
Watertown, MA 02472-1955

Mailing address

293 Mount Auburn St
Watertown, MA 02472-1955
Phone (617) 923-9446

National Provider Directory

National Provider Directory

Locations

293 Mount Auburn St
Watertown, MA 02472
Phone (617) 923-9446

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1188432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188432000000",
    "number": "1518151760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "293 MOUNT AUBURN ST",
            "city": "WATERTOWN",
            "state": "MA",
            "postal_code": "024721955",
            "telephone_number": "617-923-9446",
            "fax_number": "617-923-4750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "293 MOUNT AUBURN ST",
            "city": "WATERTOWN",
            "state": "MA",
            "postal_code": "024721955",
            "telephone_number": "617-923-9446",
            "fax_number": "617-923-4750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILIP D FANTASIA JR DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-30",
        "last_updated": "2007-08-30",
        "status": "A",
        "authorized_official_last_name": "FANTASIA",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "DOMENIC",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "617-923-9446",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "11934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.