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General NPI Number Information
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NPI Number | 1336282045
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Entity Type | Individual
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Provider Name | ROBIN SUE ELIASBERG D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 326 UNION AVE
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City | FRAMINGHAM
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State | MA
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Zip | 01702-6309
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Country | US
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Telephone | 508-875-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 3 STANFORD RD
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City | WELLESLEY
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State | MA
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Zip | 02481-1227
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Country | US
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Telephone | 508-875-1234
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 17216
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License Number State | MA
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