| Rafael Villacorta Family Dentistry | |
|
24 Crescent St Suite 303 Waltham MA 02453-4358 | |
| (781) 891-5637 | |
| (781) 891-8925 |
| Full Name | Rafael Villacorta Family Dentistry |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Pathology |
| Location | 24 Crescent St, Waltham, Massachusetts |
| Authorized Official Name and Position | Rafael E Villacorta (PRESIDENT) |
| Authorized Official Contact | 7818915637 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Rafael Villacorta Family Dentistry 24 Crescent St Suite 303 Waltham MA 02453-4358 Ph: (781) 891-5637 | Rafael Villacorta Family Dentistry 24 Crescent St Suite 303 Waltham MA 02453-4358 Ph: (781) 891-5637 |
| NPI Number | 1700057346 |
|---|---|
| Provider Enumeration Date | 03/21/2008 |
| Last Update Date | 03/21/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700057346 | NPI | - | NPPES |
| 0274771 | Medicaid | MA | |
| 9708049 | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0106X | Dentist - Oral And Maxillofacial Pathology | 18063 (Massachusetts) | Primary |
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