Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DL13729 | MA |
NPI | 1003395922 |
---|---|
Provider Name | Dr. Madeleine Wan Yong Tan |
First Address | Boston, MA 02215-5160 |
Second Address | Roslindale, MA 02131-1000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2018 |
Last Update Date | 10/08/2018 |