| NPI | 1437784378 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOANNE TAVANO CFO 978-580-1524 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2020-03-11 |
| Last Update Date | 2021-05-20 |