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General NPI Number Information
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NPI Number | 1518468099
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Entity Type | Individual
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Provider Name | GLADYS G. CARRASCO ROMAN
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Gender | Female
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Dates
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Enumeration Date | 02/21/2018
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Last Update Date | 02/22/2022
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Provider Practice Location Address
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Address Line | 180 WALNUT STREET
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City | CHELSEA
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State | MA
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Zip | 02150
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Country | US
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Telephone | 617-889-2864
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Fax |
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Provider Business Mailing Address
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Address Line | 2 INWOOD DR APT 1005
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City | WOBURN
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State | MA
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Zip | 01801-5279
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Country | US
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Telephone | 617-270-1405
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DF11267
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 016.0133993
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License Number State | VT
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