| NPI | 1205836376 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD M RUSSO CFO 781-278-5540 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2022-07-21 |