Healthcare Provider Details

I. General information

NPI: 1518884709
Provider Name (Legal Business Name): MARIA ADORACION MACIAS MARTINEZ DL101651
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 FOUNDRY AVE
WALTHAM MA
02453-8313
US

IV. Provider business mailing address

495 WESTERN AVE
BRIGHTON MA
02135-1007
US

V. Phone/Fax

Practice location:
  • Phone: 781-693-3800
  • Fax:
Mailing address:
  • Phone: 617-783-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDL101651
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: