| NPI | 1477667079 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ZAKI M MUKDISSI President Owner 781-306-9644 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 19475) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MA 19255) |
| 1223P0700X Dentist, Prosthodontics (Licence: MA 21063) | |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2020-08-22 |