| NPI | 1578882635 |
|---|---|
| Former Legal Business Name | GREAT ROAD ORTHODONTICS |
| Entity Type | Organization |
| Authorized Contact | SVEN SUPPLIES Owner/President 978-263-8358 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MA 18956) |
| Enumeration Date | 2010-05-27 |
| Last Update Date | 2010-05-27 |