Provider Demographics
NPI:1194190991
Name:ALVAREZ-NOVOA, MARTA (DDS)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:
Last Name:ALVAREZ-NOVOA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 KNEELAND ST.
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111
Mailing Address - Country:US
Mailing Address - Phone:617-636-6531
Mailing Address - Fax:617-636-0911
Practice Address - Street 1:1 KNEELAND ST.
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111
Practice Address - Country:US
Practice Address - Phone:617-636-6531
Practice Address - Fax:617-636-0911
Is Sole Proprietor?:No
Enumeration Date:2015-12-04
Last Update Date:2016-07-13
Deactivation Date:2016-07-07
Deactivation Code:
Reactivation Date:2016-07-13
Provider Licenses
StateLicense IDTaxonomies
MADL127731223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics