| NPI | 1942858063 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASUN MAHAFFEY Owner 617-957-8352 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-09-02 |
| Last Update Date | 2019-09-02 |