Healthcare Provider Details

I. General information

NPI: 1205537206
Provider Name (Legal Business Name): MARISSA BROOKE RIFKIN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1244 BOYLSTON ST STE 205
CHESTNUT HILL MA
02467-2115
US

IV. Provider business mailing address

1244 BOYLSTON ST STE 205
CHESTNUT HILL MA
02467-2115
US

V. Phone/Fax

Practice location:
  • Phone: 617-735-0800
  • Fax:
Mailing address:
  • Phone: 617-735-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN10000790
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: