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General NPI Number Information
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NPI Number | 1801550199
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Entity Type | Individual
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Provider Name | SUSANA BARRIOS PINERA D.M.D
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Gender | Female
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Dates
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Enumeration Date | 10/24/2021
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Last Update Date | 10/24/2021
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Provider Practice Location Address
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Address Line | 701 BROADWAY
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City | SOMERVILLE
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State | MA
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Zip | 02144-2223
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Country | US
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Telephone | 617-764-1454
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Fax |
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Provider Business Mailing Address
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Address Line | 69 SALMAN ST
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City | WEST ROXBURY
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State | MA
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Zip | 02132-5710
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Country | US
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Telephone | 786-502-7242
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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 | DN26511
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN1859234
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License Number State | MA
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