| NPI | 1518091180 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRA R BAXTER Administrative Assistant 781-639-4500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MA 13926) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MA 16948) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2025-09-11 |