| NPI | 1386026847 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELENA BLACK Owner 617-875-3106 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Additional Taxonomies | 1223E0200X Dentist Endodontics |
| 261QD0000X Clinic/Center Dental | |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2018-10-12 |