Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 17478 | MA |
NPI | 1013137108 |
---|---|
Provider Name | John I Cassis |
First Address | Braintree, MA 02184-7347 |
Second Address | Boston, MA 02118-2308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2007 |
Last Update Date | 08/07/2007 |