Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 20696 | MA |
NPI | 1023149424 |
---|---|
Provider Name | Jennifer Soncini |
First Address | South Boston, MA 02127-2245 |
Second Address | South Boston, MA 02127-2245 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 08/07/2007 |