| NPI | 1861246993 |
|---|---|
| Doing Business As | MAIN STREET ENDODONTICS |
| Entity Type | Organization |
| Authorized Contact | IVY ELIZABETH PRUITT Practice Owner, Endodontist 617-850-5032 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics |
| Enumeration Date | 2024-04-15 |
| Last Update Date | 2024-04-15 |