| NPI | 1700304425 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | XIUPING WANG Owner 617-953-2289 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2017-09-01 |
| Last Update Date | 2023-08-30 |