Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DL 10752 | MA |
NPI | 1154654796 |
---|---|
Provider Name | Dr. Mashael Al-Qallaf |
First Address | Quincy, MA 02169-4652 |
Second Address | Quincy, MA 02169 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2009 |
Last Update Date | 15/09/2009 |