| NPI | 1750392486 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT NICHOLAS PETROSINO Administrator 617-491-6800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: MA 14460) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2020-08-22 |