| NPI | 1376715227 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLYNN PELLOUX Office Manager 617-227-4924 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MA 12730) |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2008-04-01 |