Healthcare Provider Details

I. General information

NPI: 1841831096
Provider Name (Legal Business Name): JIMMY SAMUEL ALBURQUERQUE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 BROADWAY STE 1
EVERETT MA
02149-3614
US

IV. Provider business mailing address

26 WORCESTER ST APT 203
BOSTON MA
02118-3376
US

V. Phone/Fax

Practice location:
  • Phone: 617-389-2005
  • Fax:
Mailing address:
  • Phone: 407-724-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1858484
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: