Provider Demographics
NPI:1366142663
Name:FERREIRA, LORENA
Entity type:Individual
Prefix:
First Name:LORENA
Middle Name:
Last Name:FERREIRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:386 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-2215
Mailing Address - Country:US
Mailing Address - Phone:617-464-5825
Mailing Address - Fax:
Practice Address - Street 1:386 W BROADWAY
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-2215
Practice Address - Country:US
Practice Address - Phone:617-464-5825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2024-06-28
Deactivation Date:2024-02-16
Deactivation Code:
Reactivation Date:2024-03-12
Provider Licenses
StateLicense IDTaxonomies
MADN10000106122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist