| NPI | 1457577884 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSTAM K DE VITRE Owner 617-236-5969 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: MA 13701) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: MA 20322) |
| 1223P0300X Dentist Periodontics (Licence: MA 18265) | |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2008-08-27 |