Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DN1856563 | MA |
Y | 1223D0001X | Dental Public Health | DN1856563 | MA |
NPI | 1255744926 |
---|---|
Provider Name | Dr. Amanda Ashley Cardinale |
First Address | Dedham, MA 02026 |
Second Address | Dedham, MA 02026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2014 |
Last Update Date | 02/11/2016 |