Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 20789 | MA |
NPI | 1144247792 |
---|---|
Provider Name | Nopsaran Chaimattayompol |
First Address | Quincy, MA 02169-0908 |
Second Address | Quincy, MA 02169-0908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 08/07/2007 |