| NPI | 1053823401 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID ROBERT BEANLAND Owner 978-392-9095 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MA DN20791) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MA DN21506) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MA DN1855623) | |
| Enumeration Date | 2017-10-25 |
| Last Update Date | 2017-10-25 |