| NPI | 1114146396 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHY CASEY Office Manager 617-267-3993 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 15599) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2007-10-26 |