Individual
DR. WID JASTANEIAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
100 E NEWTON ST, BOSTON, MA 02118-2308
(857) 333-9654
Mailing address
660 WASHINGTON ST, BOSTON, MA 02111-3200
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DL12815
MA
Other
Enumeration date
02/02/2016
Last updated
02/02/2016
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