Healthcare Provider Details

I. General information

NPI: 1093627259
Provider Name (Legal Business Name): EDUARDO HENRIQUE DE SOUZA OLIVEIRA DDS, MS, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 LONGWOOD AVE
BOSTON MA
02115-5888
US

IV. Provider business mailing address

188 LONGWOOD AVE REB 314
BOSTON MA
02115-5819
US

V. Phone/Fax

Practice location:
  • Phone: 617-432-1434
  • Fax:
Mailing address:
  • Phone: 781-796-2761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDF100061
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: