Individual
RENA YVONNE SMALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
386 WARREN ST, ROXBURY, MA 02119-1830
(617) 445-1743
Mailing address
386A B WARREN STREET, ROXBURY, MA 02119
(617) 445-1743
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
15296
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
X05804SM
BLUE CROSS OF MA
MA
Enumeration date
04/09/2008
Last updated
04/09/2008
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