| NPI | 1255420535 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STANLEY WALSH President 508-995-5105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MA 17161) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MA 12969) |
| 1223G0001X Dentist General Practice (Licence: MA 11564) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2020-08-22 |