Healthcare Provider Details

I. General information

NPI: 1023967809
Provider Name (Legal Business Name): DANIELLE FIDELIS LACET DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

389 MAIN ST STE 201
MALDEN MA
02148-5017
US

IV. Provider business mailing address

290 REVOLUTION DR APT 856
SOMERVILLE MA
02145-1688
US

V. Phone/Fax

Practice location:
  • Phone: 781-322-0131
  • Fax:
Mailing address:
  • Phone: 321-315-7277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN10001636
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: