Provider Demographics
NPI:1790824985
Name:CARDENAS, MARIA E (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:E
Last Name:CARDENAS
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 1:800 BOYLSTON STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02199
Mailing Address - Country:US
Mailing Address - Phone:617-259-1100
Mailing Address - Fax:
Practice Address - Street 1:800 BOYLSTON STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02199
Practice Address - Country:US
Practice Address - Phone:617-259-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX09340OtherBLUE SHIELD