Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | D 15304 | MA |
NPI | 1144356601 |
---|---|
Provider Name | M Reza Setayesh |
First Address | Weymouth, MA 02189-1530 |
Second Address | Weymouth, MA 02189-1530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 08/07/2007 |