| NPI | 1235251695 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOREN JAY WILSON President 617-876-8636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 14418) |
| Enumeration Date | 2007-04-05 |
| Last Update Date | 2020-08-22 |