| NPI | 1912363193 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORY ERNST Owner Dentist 617-595-8023 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: ME DEN4182) |
| Enumeration Date | 2016-01-04 |
| Last Update Date | 2016-01-04 |