| NPI | 1437247889 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY A JOHNSON Periodentist 508-347-2673 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MA 12356) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2020-08-22 |