| NPI | 1902215932 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER T PHAN Owner 508-771-1415 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MA DN21842) |
| Enumeration Date | 2014-08-04 |
| Last Update Date | 2014-08-04 |