Provider Demographics
NPI:1811193006
Name:EVANGELISTI, MARIA CECILIA (DMD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:CECILIA
Last Name:EVANGELISTI
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 1:8 FREEDOM RD
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-4720
Mailing Address - Country:US
Mailing Address - Phone:781-935-6455
Mailing Address - Fax:781-935-6455
Practice Address - Street 1:14 MUZZEY ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-5223
Practice Address - Country:US
Practice Address - Phone:781-862-1068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210211223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry