| NPI | 1174099949 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ZAKI MICHAEL MUKDISSI Owner /Manager 617-386-9834 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics |
| Enumeration Date | 2018-10-19 |
| Last Update Date | 2018-10-19 |