| NPI | 1699787663 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH W COSTA Treasurer 617-739-8200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 17734) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2020-08-22 |