Healthcare Provider Details

I. General information

NPI: 1548956139
Provider Name (Legal Business Name): ALICE ZHENRONG LI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
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
BOSTON MA
02115-5819
US

V. Phone/Fax

Practice location:
  • Phone: 617-432-1434
  • Fax: 617-432-4258
Mailing address:
  • Phone: 617-432-1434
  • Fax: 617-432-4258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1859880
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN1859880
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: