| NPI | 1134373673 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN S RAISMAN Owner 508-879-8180 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MA 20480) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MA 11463) |
| 1223P0300X Dentist Periodontics (Licence: MA 20271) | |
| Enumeration Date | 2008-11-11 |
| Last Update Date | 2008-11-11 |