Individual
SANDRINE MARIE COULDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS, MS
Contact information
Practice address
151 MERRIMAC ST STE 100, BOSTON, MA 02114-4717
(617) 982-2233
Mailing address
166 QUINCY SHORE DR UNIT 112, QUINCY, MA 02171-2943
(801) 560-3658
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DN1859122
MA
1223P0300X
Periodontics
Primary
DN1859122
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0334339
UNIVERSITY OF UTAH SCHOOL OF DENTISTRY UID
—
01
—
252534
UNIVERSITY OF NORTH CAROLINA UID
—
Enumeration date
05/22/2019
Last updated
08/27/2024
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