| NPI | 1013060235 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELISSA HEARD Dentist Owner 617-471-8640 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 13671) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 17259) |
| 1223G0001X Dentist, General Practice (Licence: MA 16163) | |
| 1223G0001X Dentist, General Practice (Licence: MA 21465) | |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2020-08-22 |