Provider Demographics
NPI:1184471021
Name:MOTA, REY DANIEL (DMD)
Entity type:Individual
Prefix:
First Name:REY
Middle Name:DANIEL
Last Name:MOTA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 LEROY AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-1407
Mailing Address - Country:US
Mailing Address - Phone:978-360-3300
Mailing Address - Fax:
Practice Address - Street 1:19 N QUINSIGAMOND AVE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-2407
Practice Address - Country:US
Practice Address - Phone:508-421-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-06-14
Deactivation Date:2024-06-07
Deactivation Code:
Reactivation Date:2024-06-14
Provider Licenses
StateLicense IDTaxonomies
MADN10000285122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist