Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 22212 | MA |
NPI | 1003072588 |
---|---|
Provider Name | Dr. Sylvia C Koo |
First Address | Bourne, MA 02532 |
Second Address | Bourne, MA 02532 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2008 |
Last Update Date | 06/08/2015 |