| NPI | 1124259056 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARA ROBERTS Office Administrator 617-927-6479 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2009-07-27 |
| Last Update Date | 2009-07-27 |