| NPI | 1417127671 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VALERIY M KOSTENKO Dentist 781-581-1411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MA 19585) |
| Enumeration Date | 2008-03-04 |
| Last Update Date | 2008-03-04 |