| NPI | 1326304841 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATIE-ROSE RADIN WAGNER President 617-623-2100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MA DN1855704) |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2012-04-10 |