| NPI | 1265942700 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN NIETZER Owner/Pediatric Dentist 617-997-5902 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: SC 7003) |
| Enumeration Date | 2017-10-11 |
| Last Update Date | 2017-10-11 |