| NPI | 1093998387 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | W DAVID KELLY Member 508-799-2550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA 12222) |
| Enumeration Date | 2007-12-10 |
| Last Update Date | 2007-12-10 |