| NPI | 1093744674 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVE W BERGMAN President/Dentist 781-843-7905 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MA 15349) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: MA 18388) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2020-08-22 |