Provider Demographics
NPI:1679742035
Name:CANCADO, MARIA ANGELA V (DMD)
Entity Type:Individual
Prefix:
First Name:MARIA ANGELA
Middle Name:V
Last Name:CANCADO
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 1:281 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-1933
Mailing Address - Country:US
Mailing Address - Phone:617-591-9888
Mailing Address - Fax:
Practice Address - Street 1:55 SEWALL AVE APT 3A
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5214
Practice Address - Country:US
Practice Address - Phone:617-407-4389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9835855120000OtherBC&BSOF MASSACHUSETTS,INC