| NPI | 1659505667 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS JAMES BRAJCICH President 617-448-1347 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE 60083523) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 21884) |
| Enumeration Date | 2009-05-05 |
| Last Update Date | 2009-05-05 |