| NPI | 1013318963 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOANNE TAVANO Director 978-580-1524 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| 1223P0221X Dentist, Pediatric Dentistry | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality | |
| Enumeration Date | 2014-09-10 |
| Last Update Date | 2015-11-09 |