| NPI | 1205015179 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EKATERINA MAMULASHVILI Dentist 617-268-2333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 21211) |
| Enumeration Date | 2007-10-29 |
| Last Update Date | 2007-10-29 |