| NPI | 1518919398 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA ELOVIC Treasurer 617-247-8888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MA 17592) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 17210) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2020-08-22 |