| NPI | 1578984662 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN RICHARD GAUDREAULT Owner 508-345-7075 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MA 19702) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MA 1855240) |
| Enumeration Date | 2013-12-17 |
| Last Update Date | 2013-12-17 |