Healthcare Provider Details

I. General information

NPI: 1104617125
Provider Name (Legal Business Name): JOSELIN CRISTINA FERRANTE MATHEUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2025
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 FAIRBANKS ST
BRIGHTON MA
02135-2504
US

IV. Provider business mailing address

26 FAIRBANKS ST APT 2
BRIGHTON MA
02135-2504
US

V. Phone/Fax

Practice location:
  • Phone: 786-690-4564
  • Fax:
Mailing address:
  • Phone: 786-690-4564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number126800000X
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: