| NPI | 1184346256 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MINA CHOE BOUDREAU Owner 857-304-4153 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2022-09-15 |
| Last Update Date | 2023-03-14 |