Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DN17870 | MA |
NPI | 1346533080 |
---|---|
Provider Name | Dr. Joseph William Travers JR. |
First Address | Cambridge, MA 02138-1143 |
Second Address | Norfolk, MA 02056 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2011 |
Last Update Date | 26/05/2011 |