Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 20667 | MA |
NPI | 1114943966 |
---|---|
Provider Name | Sofia A Ostrer |
First Address | Somerville, MA 02114 |
Second Address | Somerville, MA 02114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 08/07/2007 |