Provider Demographics
NPI:1912145491
Name:RODRIGUEZ VARO, MA LETICIA
Entity Type:Individual
Prefix:
First Name:MA LETICIA
Middle Name:
Last Name:RODRIGUEZ VARO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LETICIA
Other - Middle Name:
Other - Last Name:RODRIGUEZ VARO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:302 NEWBURY ST APT 8
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-2848
Mailing Address - Country:US
Mailing Address - Phone:617-990-7198
Mailing Address - Fax:617-636-0911
Practice Address - Street 1:302 NEWBURY ST APT 8
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-2848
Practice Address - Country:US
Practice Address - Phone:617-990-7198
Practice Address - Fax:617-636-0911
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA105301223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics