Healthcare Provider Details

I. General information

NPI: 1760906796
Provider Name (Legal Business Name): MARIA F. HERNANDEZ NUNO DE LA ROSA DMD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KNEELAND ST
BOSTON MA
02111-1527
US

IV. Provider business mailing address

1 KNEELAND ST
BOSTON MA
02111-1527
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-6615
  • Fax: 617-636-6809
Mailing address:
  • Phone: 617-636-6515
  • Fax: 617-636-6809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License NumberDF11958
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: