Individual
MARINA ANN MIKAEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
590 SOUTH AVE, WESTON, MA 02493-2608
(781) 330-6236
Mailing address
590 SOUTH AVE, WESTON, MA 02493-2608
(781) 330-6236
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
107059
CA
Other
Enumeration date
04/21/2020
Last updated
12/01/2021
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