| NPI | 1417399270 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WAHID MISTIKAWI Dentist 508-339-4171 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MA DN17639) |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2013-07-22 |