| NPI | 1376662619 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL B FITZGERALD Owner 781-438-1995 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA 014305) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 016175) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2020-08-22 |