Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 18658 | MA |
NPI | 1114931383 |
---|---|
Provider Name | Paul Talkov |
First Address | Peabody, MA 01960-2910 |
Second Address | Peabody, MA 01960-2910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 08/07/2007 |