| NPI | 1023881570 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ZACHARY KOFOS Owner 617-678-3125 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2023-11-06 |
| Last Update Date | 2023-11-06 |