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 |