| NPI | 1386995397 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW R. FANTASIA President 781-235-1146 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN 20441) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MA DN 14506) |
| Enumeration Date | 2012-10-01 |
| Last Update Date | 2012-10-15 |