Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 18698 | MA |
NPI | 1043728173 |
---|---|
Provider Name | Michelle Marie Henshaw Marble |
First Address | Taunton, MA 02780-2144 |
Second Address | Boston, MA 02118-2884 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2018 |
Last Update Date | 10/01/2018 |