Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 14505 | MA |
NPI | 1003898008 |
---|---|
Provider Name | Dr. Carol Ann Lorente |
First Address | Boston, MA 02215 |
Second Address | Boston, MA 02215 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
794892 | TUFTS (01) | |
U12206 | (02) | |
X04567 | BCBS (01) |