| NPI | 1336563568 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NINA OH Dentist 617-529-5928 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1855978) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1855978) |
| Enumeration Date | 2014-02-07 |
| Last Update Date | 2014-02-11 |