Provider Demographics
NPI:1538921150
Name:SY, CHRISTINE GAVIOLA (DMD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:GAVIOLA
Last Name:SY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:PEARL CHRISTINE MAE
Other - Middle Name:QUILANG
Other - Last Name:SY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:635 ALBANY ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-3550
Mailing Address - Country:US
Mailing Address - Phone:617-358-8300
Mailing Address - Fax:
Practice Address - Street 1:1 SHERWOOD RD
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-3308
Practice Address - Country:US
Practice Address - Phone:678-818-6314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MADN10000741122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program