Provider Demographics
NPI:1326077025
Name:DISHAROON, BETSY (DMD)
Entity Type:Individual
Prefix:DR
First Name:BETSY
Middle Name:
Last Name:DISHAROON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 PARK ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-2913
Mailing Address - Country:US
Mailing Address - Phone:781-341-8966
Mailing Address - Fax:781-341-8980
Practice Address - Street 1:19 PARK ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-2913
Practice Address - Country:US
Practice Address - Phone:781-341-8966
Practice Address - Fax:781-341-8980
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA168681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice