| NPI | 1194875385 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL DEMETRIUS ATHANASOULAS President 978-454-2924 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 10609) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 15488) |
| 1223G0001X Dentist, General Practice (Licence: MA 20392) | |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2020-08-22 |