| NPI | 1457909004 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETHANY K POLNAR President 781-608-0307 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2019-08-27 |
| Last Update Date | 2021-04-22 |