| NPI | 1225517899 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AIMEE HODGERNEY Operations Manager 508-589-8270 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MA DN20511) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2018-08-14 |
| Last Update Date | 2019-05-24 |