| NPI | 1760725287 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA MICHELE MARDIS Chief Of Service 617-495-2063 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: MA 4RA2) |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2013-04-03 |