Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DN1859261 | MA |
NPI | 1033618640 |
---|---|
Provider Name | Jonathan Matthew Ang |
First Address | Mc Lean, VA 22102-5240 |
Second Address | Quincy, MA 02169-7564 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2018 |
Last Update Date | 12/01/2022 |