| NPI | 1437232238 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA ELLIS Practice Manager 617-330-8887 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 11855) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 12879) |
| 1223G0001X Dentist, General Practice (Licence: MA 18636) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2020-08-22 |