Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DN1857540 | MA |
NPI | 1053792507 |
---|---|
Provider Name | Mariam Javaid |
First Address | Holyoke, MA 01040-2703 |
Second Address | Holyoke, MA 01040-2703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2015 |
Last Update Date | 26/07/2017 |