Provider Demographics
NPI:1447365143
Name:PUCCIO, FELIX A (DDS)
Entity type:Individual
Prefix:DR
First Name:FELIX
Middle Name:A
Last Name:PUCCIO
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 1:98 CHURCH STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01247-4161
Mailing Address - Country:US
Mailing Address - Phone:413-663-7372
Mailing Address - Fax:
Practice Address - Street 1:98 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247-4161
Practice Address - Country:US
Practice Address - Phone:413-663-7372
Practice Address - Fax:413-664-4884
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA97631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice