| NPI | 1841213295 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DALE MELVIN WETMORE President 617-536-7168 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 21163) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 12755) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2020-08-22 |