| NPI | 1427454388 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAMIAN MEOLA Owner 781-860-0115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA 17511) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA dn1856618) |
| 1223E0200X Dentist, Endodontics (Licence: MA dn21623) | |
| 1223P0300X Dentist, Periodontics (Licence: MA 21707) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MA 20998) | |
| Enumeration Date | 2014-11-05 |
| Last Update Date | 2014-11-05 |