| NPI | 1609427236 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFF DONNELLY Owner 781-826-4499 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-09-25 |
| Last Update Date | 2019-09-25 |