Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 21275 | MA |
NPI | 1073736211 |
---|---|
Provider Name | Heather E Wolbach |
First Address | Norwell, MA 02061-1701 |
Second Address | Norwell, MA 02061-1701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 03/05/2011 |