| NPI | 1376818583 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCIN JARMOC Vice President 617-331-9544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN22094) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA DN1855540) |
| Enumeration Date | 2012-03-21 |
| Last Update Date | 2012-03-21 |