| NPI | 1134456346 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BERDJ KILADJIAN Resident Agent 617-738-1232 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA 17049) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 18964) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA 10426) | |
| Enumeration Date | 2009-11-09 |
| Last Update Date | 2009-11-09 |