| NPI | 1932437936 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE FICALORA Dentist 617-484-1760 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 17482) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MA 20292) |
| Enumeration Date | 2009-12-02 |
| Last Update Date | 2009-12-02 |