Healthcare Provider Details

I. General information

NPI: 1699518571
Provider Name (Legal Business Name): DR. LUIZ HENRIQUE MARTINS ASSUNCAO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 QUEEN ST
WORCESTER MA
01610
US

IV. Provider business mailing address

593 RIVANNA HILL RD
GLEN ALLEN VA
23060-4041
US

V. Phone/Fax

Practice location:
  • Phone: 508-860-7700
  • Fax:
Mailing address:
  • Phone: 804-933-4037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401419704
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: