| NPI | 1285148494 |
|---|---|
| Doing Business As | OUR DENTIST OF WESTERN MASSACHUSETTS |
| Entity Type | Organization |
| Authorized Contact | CASSANDRA PETERSEN Credentialing Team Lead 217-540-8972 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2017-11-27 |
| Last Update Date | 2017-11-27 |