| NPI | 1568832558 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALIREZA OMID RAJAEI Owner 617-599-0599 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MD 13854) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 13854) |
| Enumeration Date | 2015-10-02 |
| Last Update Date | 2019-06-17 |