Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH13282 | MA |
NPI | 1013308592 |
---|---|
Provider Name | Saira Ghany |
First Address | Brockton, MA 02301-4042 |
Second Address | Brockton, MA 02301-4042 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2015 |
Last Update Date | 05/02/2015 |