| NPI | 1417026584 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IGOR A LOZADA Owner 617-566-1524 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MA 19569) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 20430) |
| 1223P0300X Dentist, Periodontics (Licence: MA 19177) | |
| 1223P0700X Dentist, Prosthodontics (Licence: MA 20430) | |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2020-08-22 |