| NPI | 1770947301 |
|---|---|
| Former Legal Business Name | TRACI A PORTNOFF, DMD, PC |
| Entity Type | Organization |
| Authorized Contact | TRACI ALLISON PORTNOFF President 508-366-3623 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA 19517) |
| Enumeration Date | 2016-04-10 |
| Last Update Date | 2016-04-10 |