Provider Demographics
NPI:1558349357
Name:HOM, PAMELA JADE (DMD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JADE
Last Name:HOM
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 1:290 BAKER AVE
Mailing Address - Street 2:SUITE N228
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2189
Mailing Address - Country:US
Mailing Address - Phone:978-369-7771
Mailing Address - Fax:
Practice Address - Street 1:290 BAKER AVE
Practice Address - Street 2:SUITE N228
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2189
Practice Address - Country:US
Practice Address - Phone:978-369-7771
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA192621223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry