Individual
DR. POORNIMA MYSORE VISHWANATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
314 MOODY ST, WALTHAM, MA 02453-5202
(781) 398-0000
Mailing address
9 FIFER LN, LEXINGTON, MA 02420-1231
(512) 674-5336
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN1859211
MA
Other
Enumeration date
09/30/2021
Last updated
09/30/2021
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