| NPI | 1285750596 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURIE MANTHOS Owner 508-752-2100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA 16823) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2008-01-11 |