Healthcare Provider Details

I. General information

NPI: 1699606319
Provider Name (Legal Business Name): CLAUDIA MONTEVERDE LA ROCHE DL101561
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 WESTERN AVE
BOSTON MA
02135-1007
US

IV. Provider business mailing address

250 HAMMOND POND PKWY APT 312S
CHESTNUT HILL MA
02467-1505
US

V. Phone/Fax

Practice location:
  • Phone: 617-783-0500
  • Fax:
Mailing address:
  • Phone: 857-415-9346
  • Fax: 857-415-9346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDL101561
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: