Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DL13417 | MA |
NPI | 1194243444 |
---|---|
Provider Name | Maryam Alsaffar |
First Address | Boston, MA 02111-3231 |
Second Address | Boston, MA 02111-1527 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2017 |
Last Update Date | 07/09/2017 |