Healthcare Provider Details

I. General information

NPI: 1013182708
Provider Name (Legal Business Name): NEWTON CENTRE ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 LYMAN ST
NEWTON MA
02459-1921
US

IV. Provider business mailing address

4 LYMAN ST
NEWTON MA
02459-1921
US

V. Phone/Fax

Practice location:
  • Phone: 617-332-2434
  • Fax: 617-332-5180
Mailing address:
  • Phone: 617-332-2434
  • Fax: 617-332-5180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number20517
License Number StateMA

VIII. Authorized Official

Name: DR. ROBERTO S CARVALHO
Title or Position: OWNER/ORTHODONTIST
Credential: DMD, PHD
Phone: 617-332-2434