Provider Demographics
NPI:1780113266
Name:CASTELLUCCI, WYSOCKI AND OSORIO DENTAL GROUP, LLC
Entity type:Organization
Organization Name:CASTELLUCCI, WYSOCKI AND OSORIO DENTAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WYSOCKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-358-7100
Mailing Address - Street 1:311 BOSTON POST RD UNIT 1
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-1802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:311 BOSTON POST RD UNIT 1
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-1802
Practice Address - Country:US
Practice Address - Phone:508-358-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty