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Provider Information for 1689793788

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1689793788

Calendar   Last Updated:  2007-07-08
  Certification Date: 


Name Value
NPI 1689793788
Enumeration Date 2007-03-28
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 2191 BAY RD
SHARON, MA 02067-3027
United States

Phone: 339-364-0181 | Fax:
View Map External Link
Primary Practice Address 21 BAY STATE RD
BOSTON, MA 02215-2101
United States

Phone: 617-247-9966 | Fax: 617-266-0679
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice MA 18108