Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 9701 | MA |
NPI | 1124287230 |
---|---|
Provider Name | Dr. Charbel Zalloum |
First Address | Dorchester, MA 02122-2932 |
Second Address | Dorchester, MA 02122-2932 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2008 |
Last Update Date | 03/06/2008 |