| NPI | 1164094330 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAMATA MUKKARA Orthodontist 617-480-2348 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2021-07-15 |
| Last Update Date | 2021-07-15 |