Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DL14770 | MA |
NPI | 1003433160 |
---|---|
Provider Name | Nicha Tokavanich |
First Address | Boston, MA 02215-5406 |
Second Address | Boston, MA 02115-5819 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2020 |
Last Update Date | 27/05/2021 |