Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 14251 | MA |
NPI | 1053389098 |
---|---|
Provider Name | Dr. Thomas Francis Mcgillicuddy JR. |
First Address | Needham, MA 02492-2515 |
Second Address | Needham, MA 02492-2515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2006 |
Last Update Date | 08/07/2007 |