| NPI | 1962414748 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARRETT K PISKOR Owner 617-547-4958 |
| Organization Subpart ? | No |
| Primary Taxonomy | 126900000X Dental Laboratory Technician (Licence: MA 15316) |
| Additional Taxonomies | 126900000X Dental Laboratory Technician (Licence: MA 12217) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2013-01-14 |