| NPI | 1417980152 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN E WARD Insurance Coordinator 617-965-2440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 17699) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MA 20667) |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2020-08-22 |