Provider Demographics
NPI:1295971992
Name:DONNA M. PONTE PEREIRA, DMD, LLC
Entity type:Organization
Organization Name:DONNA M. PONTE PEREIRA, DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PONTE PEREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-492-7626
Mailing Address - Street 1:825 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-1429
Mailing Address - Country:US
Mailing Address - Phone:617-492-7626
Mailing Address - Fax:
Practice Address - Street 1:826 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02141-1402
Practice Address - Country:US
Practice Address - Phone:617-492-7626
Practice Address - Fax:617-492-7629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA174611223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty