Individual
DR. ITALLO EMIDIO LIRA VIANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MSC, PHD
Contact information
Practice address
25 MORRISSEY BLVD UNIT 1205, BOSTON, MA 02125-3355
(857) 313-5993
Mailing address
25 MORRISSEY BLVD UNIT 1205, BOSTON, MA 02125-3355
(857) 313-5993
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DF12023
MA
Other
Enumeration date
05/31/2024
Last updated
05/31/2024
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