Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DL12359 | MA |
NPI | 1033511050 |
---|---|
Provider Name | Neda Rajablou |
First Address | Boston, MA 02118-2308 |
Second Address | Boston, MA 02118-2308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2014 |
Last Update Date | 22/09/2014 |