| NPI | 1922210616 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAM LEVINE President 781-860-9473 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MA 21310) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2013-05-09 |