Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DN1857878 | MA |
NPI | 1124548060 |
---|---|
Provider Name | Dr. Kathleen Molgaard |
First Address | Boston, MA 02111-1624 |
Second Address | Waltham, MA 02452-8475 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2017 |
Last Update Date | 09/10/2019 |