Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 1856544 | MA |
NPI | 1013310242 |
---|---|
Provider Name | Dr. Ella Osborn |
First Address | Boston, MA 02210-1994 |
Second Address | Boston, MA 02210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2014 |
Last Update Date | 04/04/2019 |