Provider Demographics
NPI:1285087999
Name:LA, NAOMI (DMD)
Entity type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:
Last Name:LA
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 1:302 BAY DR
Mailing Address - Street 2:
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-3403
Mailing Address - Country:US
Mailing Address - Phone:617-817-6346
Mailing Address - Fax:
Practice Address - Street 1:162 CORDAVILLE RD STE 175
Practice Address - Street 2:
Practice Address - City:SOUTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01772-1838
Practice Address - Country:US
Practice Address - Phone:617-453-8397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18583921223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry