| NPI | 1467925529 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN S LEE President 617-833-0158 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2019-01-10 |
| Last Update Date | 2020-10-13 |