| NPI | 1649644667 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA MARIE GIARRUSSO Orthodontist, Treasurer, Owner 508-832-5776 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN17729) |
| Enumeration Date | 2015-11-16 |
| Last Update Date | 2015-11-16 |