| NPI | 1396215778 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL GONZALEZ Owner 617-548-6717 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| 261QD0000X Clinic/Center, Dental | |
| Enumeration Date | 2018-11-28 |
| Last Update Date | 2018-11-28 |