| NPI | 1417962903 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN C GAGNON Pres 508-548-2999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 18496) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 18760) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2020-08-22 |