Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | 12010332A | MI |
Y | 1223D0001X | Dental Public Health | 14113 | MA |
NPI | 1356435077 |
---|---|
Provider Name | Dr. B Gail Demko |
First Address | Weston, MA 02493-0004 |
Second Address | Weston, MA 02493-1319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 30/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6491640001 | PTAN (01) | MA |
T57245 | (02) | |
T57245 | (02) | MA |