| NPI | 1578582623 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY GWOZDZ Secretary 508-998-1232 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2008-09-18 |