Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DN1857171 | MA |
NPI | 1255710034 |
---|---|
Provider Name | Dr. Erinne Nicole Kennedy |
First Address | Boston, MA 02118-2976 |
Second Address | Quincy, MA 02169 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2015 |
Last Update Date | 31/03/2020 |