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General NPI Number Information
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NPI Number | 1295971992
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Entity Type | Organization
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Legal Business Name | DONNA M. PONTE PEREIRA, DMD, LLC
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Dates
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Enumeration Date | 12/30/2008
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Last Update Date | 12/30/2008
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Provider Practice Location Address
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Address Line | 826 CAMBRIDGE ST
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City | CAMBRIDGE
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State | MA
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Zip | 02141-1402
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Country | US
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Telephone | 617-492-7626
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Fax | 617-492-7629
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Provider Business Mailing Address
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Address Line | 825 CAMBRIDGE ST
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City | CAMBRIDGE
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State | MA
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Zip | 02141-1429
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Country | US
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Telephone | 617-492-7626
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DONNA MARIE PONTE PEREIRA
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Credential | DMD
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Telephone | 617-492-7626
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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 | 17461
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License Number State | MA
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