| NPI | 1386460483 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID PARK Owner 617-259-7763 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| Enumeration Date | 2024-11-23 |
| Last Update Date | 2024-11-23 |