Individual
AN AN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
32 TREMONT ST, BOSTON, MA 02108-3201
(617) 681-4188
Mailing address
32 TREMONT ST, BOSTON, MA 02108-3201
(617) 681-4188
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN1859468
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/21/2022
Last updated
09/16/2023
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