| NPI | 1205146248 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL G BROUTSAS Oral Surgeon 508-824-7023 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA 12159) |
| Enumeration Date | 2010-10-08 |
| Last Update Date | 2010-10-08 |