Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 21594 | MA |
NPI | 1174649891 |
---|---|
Provider Name | Dr. Laura Simon |
First Address | Boston, MA 02116-2327 |
Second Address | Arlington, MA 02474-1225 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 08/07/2007 |