Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DL12056 | MA |
NPI | 1043646417 |
---|---|
Provider Name | Haytham S Jaha |
First Address | Malden, MA 02148-4832 |
Second Address | Boston, MA 02118-2308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2013 |
Last Update Date | 17/09/2013 |