| NPI | 1083168132 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOANNE TAVANO COO 978-580-1524 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA 20209) |
| Additional Taxonomies | 305S00000X Point of Service (Licence: MA 20209) |
| Enumeration Date | 2016-08-06 |
| Last Update Date | 2016-09-14 |