Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 19884 | MA |
NPI | 1083839435 |
---|---|
Provider Name | Dr. Maria Luisa Georgaklis |
First Address | Brookline, MA 02445-1901 |
Second Address | Brookline, MA 02445-1901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 08/07/2007 |