| NPI | 1073867529 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL ANTHONY FUGAZZOTTO Owner 617-696-7257 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA 14401) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 21392) |
| Enumeration Date | 2012-11-06 |
| Last Update Date | 2012-11-06 |