Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH88298 | MA |
NPI | 1003293440 |
---|---|
Provider Name | Jacqueline Petit |
First Address | Wellesley, MA 02482-3744 |
Second Address | Wellesley, MA 02482-3744 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2015 |
Last Update Date | 06/05/2015 |