Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DN1856533 | MA |
N | 1223P0700X | Prosthodontist | DN1856533 | MA |
NPI | 1053725457 |
---|---|
Provider Name | Dr. Ashley Ali Amini-Sami |
First Address | Boston, MA 02115 |
Second Address | Boston, MA 02115 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2014 |
Last Update Date | 07/06/2017 |