Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH87306 | MA |
NPI | 1003135476 |
---|---|
Provider Name | Miss Jennifer Lynn Tran |
First Address | Malden, MA 02148-3919 |
Second Address | Boston, MA 02111-2826 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2010 |
Last Update Date | 25/05/2010 |