| NPI | 1396415295 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADRINA DEVITRE President 617-800-7543 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics |
| 1223G0001X Dentist, General Practice | |
| 1223P0300X Dentist, Periodontics | |
| 1223P0700X Dentist, Prosthodontics | |
| Enumeration Date | 2021-09-14 |
| Last Update Date | 2021-09-14 |