Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DN1856830 | MA |
NPI | 1003235268 |
---|---|
Provider Name | Jenny Citrin |
First Address | North Adams, MA 01247-2629 |
Second Address | North Adams, MA 01247-2629 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2014 |
Last Update Date | 26/06/2015 |