Provider Demographics
NPI:1578711479
Name:SEQUERRA, SILVIA (DMD)
Entity Type:Individual
Prefix:
First Name:SILVIA
Middle Name:
Last Name:SEQUERRA
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 1:45 AUBURN ST APT 9
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-4849
Mailing Address - Country:US
Mailing Address - Phone:508-688-7672
Mailing Address - Fax:
Practice Address - Street 1:1125 TREMONT STREET
Practice Address - Street 2:WHITTIER STREET HEALTH CENTER
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02120
Practice Address - Country:US
Practice Address - Phone:617-989-3242
Practice Address - Fax:617-989-3247
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10156122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist