| NPI | 1699943613 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTOR DIETZ Owner 508-872-0011 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MA 11059) |
| Enumeration Date | 2008-02-12 |
| Last Update Date | 2008-02-12 |