Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 17242 | MA |
NPI | 1043230261 |
---|---|
Provider Name | Dr. Janice T Keefe |
First Address | Braintree, MA 02184-4705 |
Second Address | Braintree, MA 02184-4705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
XO6710 | BC/BS OF MASSACHUSETTS ID (01) | MA |