Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 20910 | MA |
Y | 122300000X | Dentist | 3448 | NH |
N | 122300000X | Dentist | 3731 | ME |
NPI | 1013019942 |
---|---|
Provider Name | Marina E Becker |
First Address | Allston, MA 02134-2549 |
Second Address | Manchester, NH 03103-5070 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 08/07/2007 |