Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DL11464 | MA |
NPI | 1235455486 |
---|---|
Provider Name | Dr. Ronald Magembe |
First Address | Lexington, MA 02421-7523 |
Second Address | Gardner, MA 01440-2637 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2010 |
Last Update Date | 07/05/2012 |