Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 17210 | MA |
N | 1223P0106X | Oral and Maxillofacial Pathology | 17210 | MA |
NPI | 1548389802 |
---|---|
Provider Name | Aram Elazar Elovic |
First Address | Boston, MA 02215-3202 |
Second Address | Boston, MA 02215-3202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 08/07/2007 |