Healthcare Provider Details

I. General information

NPI: 1164653192
Provider Name (Legal Business Name): CORALIE SCHNEIDER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2009
Last Update Date: 08/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 LONGWOOD AVE
BOSTON MA
02115-5819
US

IV. Provider business mailing address

53 CONCORD AVE APT 3
SOMERVILLE MA
02143-3927
US

V. Phone/Fax

Practice location:
  • Phone: 617-432-0311
  • Fax: 617-432-3881
Mailing address:
  • Phone: 617-820-6152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDL10716
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: