| NPI | 1134367584 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDITA OUTERICKA President 508-261-9261 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MA 20471) |
| Enumeration Date | 2009-01-22 |
| Last Update Date | 2009-01-22 |