| NPI | 1407417546 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH STIPHO Owner 508-626-8338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| 1223P0300X Dentist, Periodontics | |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2019-06-27 |