Healthcare Provider Details

I. General information

NPI: 1992406623
Provider Name (Legal Business Name): JUDITH ALEJANDRA OROPEZA ARAQUE DMD, MSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2023
Last Update Date: 10/21/2023
Certification Date: 10/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 E NEWTON ST APT 402
BOSTON MA
02118-4806
US

IV. Provider business mailing address

1 ROBERTS RD
WELLESLEY MA
02481-2849
US

V. Phone/Fax

Practice location:
  • Phone: 857-204-4398
  • Fax:
Mailing address:
  • Phone: 857-204-4398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN1860012
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: