| NPI | 1770347858 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA HOULE Credentialing Specialist 508-589-8270 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics |
| 1223P0221X Dentist, Pediatric Dentistry | |
| 1223P0300X Dentist, Periodontics | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2024-02-09 |
| Last Update Date | 2024-02-09 |