| NPI | 1528402112 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ARIEL BALES-KOGAN Orthodontist 617-319-4180 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 055373) |
| Enumeration Date | 2013-04-25 |
| Last Update Date | 2013-04-25 |