Healthcare Provider Details

I. General information

NPI: 1770751463
Provider Name (Legal Business Name): DANIEL OREADI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KNEELAND ST DHS-5
BOSTON MA
02111-1527
US

IV. Provider business mailing address

1 KNEELAND ST SUITE 503
BOSTON MA
02111-1527
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-6615
  • Fax: 617-636-6809
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN1856310
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDN1856310
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: