Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 9978 | MA |
NPI | 1154586410 |
---|---|
Provider Name | Dr. Diana Paczesny |
First Address | Brookline, MA 02445-7129 |
Second Address | Brookline, MA 02445-7129 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2008 |
Last Update Date | 25/07/2008 |