Provider Demographics
NPI:1114627809
Name:SARDINAS NARANJO, ROCIO (DMD)
Entity Type:Individual
Prefix:
First Name:ROCIO
Middle Name:
Last Name:SARDINAS NARANJO
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 1:13 SHETLAND ST APT 201
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-4208
Mailing Address - Country:US
Mailing Address - Phone:305-549-0245
Mailing Address - Fax:
Practice Address - Street 1:68 EDGERLY RD
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-4208
Practice Address - Country:US
Practice Address - Phone:617-262-5880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18599981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice