Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DN1857492 | MA |
NPI | 1093255317 |
---|---|
Provider Name | Julie Hantson |
First Address | Fort Lauderdale, FL 33301-2417 |
Second Address | Marshfield, MA 02050-2193 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2017 |
Last Update Date | 13/11/2019 |