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General NPI Number Information
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NPI Number | 1235258955
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Entity Type | Individual
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Provider Name | LAURA BECERRA DMD, CAGS, MSD
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Gender | Female
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | 210 WHITING ST STE 1
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City | HINGHAM
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State | MA
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Zip | 02043-3724
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Country | US
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Telephone | 781-749-6050
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Fax |
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Provider Business Mailing Address
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Address Line | 42 WANDERS DR
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City | HINGHAM
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State | MA
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Zip | 02043-3433
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Country | US
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Telephone | 617-610-6169
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DN1855533
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License Number State | MA
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