Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | MA12925 | MA |
NPI | 1144246810 |
---|---|
Provider Name | Ronald G Weissman |
First Address | Waltham, MA 02451-7414 |
Second Address | Waltham, MA 02451-7414 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 08/07/2007 |