| NPI | 1306235064 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GABRIEL BOUSTANI President 617-640-4637 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MA 21631) |
| Enumeration Date | 2015-01-20 |
| Last Update Date | 2015-01-23 |