Provider Demographics
NPI:1235258955
Name:BECERRA, LAURA (DMD, CAGS, MSD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BECERRA
Suffix:
Gender:F
Credentials:DMD, CAGS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 WANDERS DR
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-3433
Mailing Address - Country:US
Mailing Address - Phone:617-610-6169
Mailing Address - Fax:
Practice Address - Street 1:210 WHITING ST STE 1
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-3724
Practice Address - Country:US
Practice Address - Phone:781-749-6050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18555331223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics