| NPI | 1245957604 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THEODORE MARKOS President/ Dentist 617-909-5459 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2022-10-25 |
| Last Update Date | 2023-06-05 |