| NPI | 1720320377 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EUGENE A MICKEY President/Owner 781-279-2400 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: MA DN20656) |
| Enumeration Date | 2013-03-21 |
| Last Update Date | 2013-03-21 |