| NPI | 1326299702 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIBA DASTJERDI Independant Contractor/Dentist 781-599-4505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA 21835) |
| Enumeration Date | 2008-10-03 |
| Last Update Date | 2009-01-06 |