Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 19265 | MA |
Y | 1223P0221X | Pediatric Dentist | 19265 | MA |
NPI | 1063418085 |
---|---|
Provider Name | Dr. Wendy Ruth Cheney |
First Address | Brookline, MA 02445-4513 |
Second Address | Brighton, MA 02135-3602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2005 |
Last Update Date | 30/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0281158 | (05) | MA |