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General NPI Number Information
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NPI Number | 1063839207
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Entity Type | Organization
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Legal Business Name | DEDHAM ACUPUNCTURE, LLC
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Dates
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Enumeration Date | 03/26/2014
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Last Update Date | 03/26/2014
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Provider Practice Location Address
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Address Line | 111 EASTERN AVE
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City | DEDHAM
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State | MA
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Zip | 02026-4515
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Country | US
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Telephone | 781-686-2395
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Fax | 781-326-2277
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Provider Business Mailing Address
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Address Line | 111 EASTERN AVE
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City | DEDHAM
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State | MA
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Zip | 02026-4515
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Country | US
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Telephone | 781-686-2395
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Fax | 781-326-2277
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Authorized Official
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Title or Position | OWNER
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Name | NICOLE LYNN STERN
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Credential | M.AC, LIC.AC
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Telephone | 781-686-2395
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 216170
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License Number State | MA
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