| NPI | 1417292269 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID NICHOLAS BARDWELL Sole Trustee 978-683-8855 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 16194) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 16194) |
| Enumeration Date | 2012-12-05 |
| Last Update Date | 2017-03-07 |