Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DN10094 | MA |
NPI | 1699271528 |
---|---|
Provider Name | Myron Allukian JR. |
First Address | Boston, MA 02130-3423 |
Second Address | Boston, MA 02130-3423 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2018 |
Last Update Date | 31/03/2018 |