| NPI | 1568831493 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL LANG FORMAN Owner 617-868-5500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MA DN18021) |
| Enumeration Date | 2015-09-22 |
| Last Update Date | 2015-09-22 |