| NPI | 1518151760 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILIP DOMENIC FANTASIA Dentist 617-923-9446 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MA 11934) |
| Enumeration Date | 2007-08-30 |
| Last Update Date | 2007-08-30 |