Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DL14878 | MA |
NPI | 1104499466 |
---|---|
Provider Name | Ali Abdallah |
First Address | Boston, MA 02118-3478 |
Second Address | Boston, MA 02215-1274 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2021 |
Last Update Date | 22/07/2021 |