Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DN1855205 | MA |
NPI | 1003016429 |
---|---|
Provider Name | Sally Hua |
First Address | Weymouth, MA 02188-2108 |
Second Address | Weymouth, MA 02188-2108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2007 |
Last Update Date | 21/10/2016 |