| NPI | 1386852846 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK ALAN CADDELL Owner 781-324-6200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MA 20280) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 14164) |
| 1223P0300X Dentist, Periodontics (Licence: MA 19312) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2020-08-22 |