| NPI | 1164440517 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELLIOT W SALLOWAY President Treasurer 508-752-1302 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: MA 9215) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2020-08-22 |