| NPI | 1194812677 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA ELOVIC Treasurer 781-784-6573 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 17210) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MA 17592) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2020-08-22 |