| NPI | 1407552334 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WAEL ATT Owener 617-236-5969 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| 1223P0300X Dentist, Periodontics | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| Enumeration Date | 2023-02-02 |
| Last Update Date | 2023-02-02 |