| NPI | 1629113220 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA L. JEROME Receptionist 413-443-0703 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MA 13078) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2008-04-30 |