| NPI | 1639241052 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA L. WANG Owner 781-237-3031 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics |
| 1223P0300X Dentist, Periodontics | |
| 1223P0700X Dentist, Prosthodontics | |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2021-07-15 |