Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DN1856304 | MA |
NPI | 1053666917 |
---|---|
Provider Name | Dr. Boris Stein |
First Address | Shrewsbury, MA 01545 |
Second Address | Brookline, MA 02446 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2012 |
Last Update Date | 01/07/2015 |