| NPI | 1902176514 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN E FITZGERALD Sole Member,Owner 781-942-1622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 16226) |
| Enumeration Date | 2012-01-12 |
| Last Update Date | 2012-01-12 |