| NPI | 1083882716 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIA LOURDES LONGO President 617-738-7210 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 0017181) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 21390) |
| 1223P0300X Dentist, Periodontics (Licence: MA 18432) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MA 17415) | |
| Enumeration Date | 2008-02-15 |
| Last Update Date | 2008-02-15 |