Provider Demographics
NPI:1538376165
Name:KNASAS IRWIN, MARYANNE (DMD)
Entity type:Individual
Prefix:DR
First Name:MARYANNE
Middle Name:
Last Name:KNASAS IRWIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 BUTLER RD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-2238
Mailing Address - Country:US
Mailing Address - Phone:617-943-4936
Mailing Address - Fax:
Practice Address - Street 1:ONE KNEELAND ST
Practice Address - Street 2:ENDODONTICS DEPT - 4TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111
Practice Address - Country:US
Practice Address - Phone:617-636-6796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213911223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics