Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 17981 | MA |
NPI | 1003835836 |
---|---|
Provider Name | Dr. Christina Dibona Pastan |
First Address | Marblehead, MA 01945-3711 |
Second Address | Marblehead, MA 01945-3711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 08/07/2007 |