| NPI | 1215390208 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LIAT B MOORE Dentist 781-659-4034 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MA DN19970) |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2016-03-29 |