| NPI | 1649043852 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIN WILBUR Director Of Operations 617-877-9429 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics |
| Additional Taxonomies | 1223G0001X Dentist General Practice |
| 1223P0700X Dentist Prosthodontics | |
| Enumeration Date | 2023-10-31 |
| Last Update Date | 2023-10-31 |