Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 17153 | MA |
NPI | 1033270020 |
---|---|
Provider Name | Steven Corliss |
First Address | Wellesley, MA 02481 |
Second Address | Wellesley, MA 02481 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 08/07/2007 |