| NPI | 1356794069 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIO LUCCA Owner 617-300-0345 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA DN20676) |
| Enumeration Date | 2016-07-18 |
| Last Update Date | 2016-07-18 |