Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 33827 | TX |
Y | 1223P0700X | Prosthodontist | DF11527 | MA |
NPI | 1124504501 |
---|---|
Provider Name | Dr. Neil Griseto |
First Address | Boston, MA 02115-5888 |
Second Address | Boston, MA 02115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2018 |
Last Update Date | 06/11/2019 |