Healthcare Provider Details

I. General information

NPI: 1740083955
Provider Name (Legal Business Name): LAUREN ASHLEY QUINTELA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 MAIN ST
WALTHAM MA
02451-7447
US

IV. Provider business mailing address

1030 MAIN ST
WALTHAM MA
02451-7447
US

V. Phone/Fax

Practice location:
  • Phone: 781-666-6000
  • Fax:
Mailing address:
  • Phone: 954-809-8934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN10001360
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: