Healthcare Provider Details

I. General information

NPI: 1871858233
Provider Name (Legal Business Name): DEREK NOBREGA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 WASHINGTON ST
PLAINVILLE MA
02762-2641
US

IV. Provider business mailing address

209 HARVARD ST FL 2
BROOKLINE MA
02446-5071
US

V. Phone/Fax

Practice location:
  • Phone: 508-695-2064
  • Fax:
Mailing address:
  • Phone: 617-870-6511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN1856558
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: