Provider Demographics
NPI:1871610584
Name:ERIC D DIONNE DDS PC
Entity type:Organization
Organization Name:ERIC D DIONNE DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:DARIUS
Authorized Official - Last Name:DIONNE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:617-378-8277
Mailing Address - Street 1:80 HOPE AVE
Mailing Address - Street 2:SUITE #518
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-2743
Mailing Address - Country:US
Mailing Address - Phone:617-378-8277
Mailing Address - Fax:
Practice Address - Street 1:255 PARK AVE
Practice Address - Street 2:SUITE 3303
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1953
Practice Address - Country:US
Practice Address - Phone:508-755-3636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA195691223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty