| NPI | 1720602287 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOANNE TAVANO CFO 978-580-1524 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2020-06-01 |
| Last Update Date | 2020-06-23 |