| NPI | 1285035865 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIE COLLINS Office Manager 617-472-1287 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA 19975) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 19975) |
| Enumeration Date | 2014-09-15 |
| Last Update Date | 2014-09-15 |