| NPI | 1104593722 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASEY LONABOCKER VP Operations & Strategy 617-535-3364 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2021-08-23 |
| Last Update Date | 2024-11-20 |