| NPI | 1619640380 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MA DN1859821) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL14882) |
| 1223D0004X Dentist Dentist Anesthesiologist (Licence: MA DN1859821) | |
| 1223E0200X Dentist Endodontics (Licence: MA DN1859821) | |
| 1223G0001X Dentist General Practice (Licence: MA FY1029506) | |
| 1223P0221X Dentist Pediatric Dentistry (Licence: MA DN1859821) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MA DN1859821) | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: MA DN1859821) | |
| Enumeration Date | 2021-07-28 |
| Last Update Date | 2023-10-16 |