| NPI | 1124484001 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DMITRY GRIGORY MERZON Owner 617-207-8667 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MA 1258907) |
| Enumeration Date | 2016-01-08 |
| Last Update Date | 2016-01-26 |