| NPI | 1083169429 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON DOUGLAS ROBIULLARD Member 617-359-3427 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN21339) |
| Enumeration Date | 2016-08-15 |
| Last Update Date | 2016-08-15 |