| NPI | 1164651550 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN DOUGLAS BLISSETT Prosthodontist 617-738-1950 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MA 21630) |
| Enumeration Date | 2009-07-07 |
| Last Update Date | 2009-07-07 |