| NPI | 1114095361 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN RICHARD GAUDREAULT President 508-587-8623 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MA 19702) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2016-10-03 |