Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 20393 | MA |
NPI | 1154415362 |
---|---|
Provider Name | Dr. Elina Fooks |
First Address | Revere, MA 02151-1314 |
Second Address | Revere, MA 02151-1314 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 21/09/2009 |