Individual
MISS ESRA M. FADEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 KNEELAND ST, BOSTON, MA 02111-1527
(617) 817-0656
Mailing address
75 STATION LNDG, APT. 526, MEDFORD, MA, MEDFORD, MA 02155-5127
(617) 817-0656
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
13-J-D-0030293
ZZ
Other
Enumeration date
08/16/2016
Last updated
08/16/2016
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