| NPI | 1154758084 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLYN COPPE Account Manager 781-861-6120 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MA 11347) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty (Licence: MA 11347) |
| Enumeration Date | 2013-10-10 |
| Last Update Date | 2016-01-14 |