Provider Demographics
NPI:1083463715
Name:IACOMACCI, MARIA FERNANDA (DMD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:FERNANDA
Last Name:IACOMACCI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 SE 14TH TER APT 804
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-3415
Mailing Address - Country:US
Mailing Address - Phone:617-435-0892
Mailing Address - Fax:
Practice Address - Street 1:117 DRUM HILL RD
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-1505
Practice Address - Country:US
Practice Address - Phone:978-674-8571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN10000334122300000X
MAPENDING122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist