Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | #14735 | MA |
NPI | 1043447212 |
---|---|
Provider Name | Mahpareh Marefat |
First Address | West Borough, MA 01581 |
Second Address | West Borough, MA 01581 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2009 |
Last Update Date | 16/06/2009 |