| NPI | 1740919000 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASEY LONABOCKER Vice President Operations 617-535-3305 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2022-06-09 |
| Last Update Date | 2024-05-10 |