| NPI | 1164507513 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRAD WATTERWORTH President 603-431-7616 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2010-08-31 |