Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 17592 | MA |
NPI | 1053430348 |
---|---|
Provider Name | Dr. Rebecca Pechenik Elovic |
First Address | Boston, MA 02215-3202 |
Second Address | Boston, MA 02215-3202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 08/07/2007 |