Healthcare Provider Details

I. General information

NPI: 1366201360
Provider Name (Legal Business Name): VERONIKA GOGIIA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2024
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 STANIFORD ST
BOSTON MA
02114-2517
US

IV. Provider business mailing address

225 HANCOCK ST APT 3427
QUINCY MA
02171-2594
US

V. Phone/Fax

Practice location:
  • Phone: 617-581-0689
  • Fax:
Mailing address:
  • Phone: 347-727-9211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDN10000297
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: