Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | DN1856798 | MA |
N | 1223P0106X | Oral and Maxillofacial Pathology | DS0000008292 | TN |
NPI | 1376941880 |
---|---|
Provider Name | Tanya Wright |
First Address | Boston, MA 02111-1527 |
Second Address | Boston, MA 02111-1527 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2014 |
Last Update Date | 15/12/2020 |