| NPI | 1902929961 |
|---|---|
| Other Name | MOUNT IDA COLLEGE DENTAL CENTER |
| Entity Type | Organization |
| Authorized Contact | GARY MELVIN BECKETT Supervising Dentist 617-928-7360 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 15111) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2020-08-22 |