Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223E0200X | Endodontist | 55412 | CA |
Y | 1223E0200X | Endodontist | DN1858129 | MA |
NPI | 1093971210 |
---|---|
Provider Name | Dr. Jennifer L Gibbs |
First Address | Boston, MA 02115-5819 |
Second Address | Boston, MA 02115-5819 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2008 |
Last Update Date | 30/05/2019 |