Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 10364 | MA |
NPI | 1073764676 |
---|---|
Provider Name | Dr. Anuradha N Deshmukh |
First Address | Canton, MA 02021-1926 |
Second Address | Boston, MA 02118-2308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2008 |
Last Update Date | 02/10/2008 |