| NPI | 1417162165 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYMOND GEORGE President 508-761-5230 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: RI 2220) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: MA 16514) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2020-08-22 |