| NPI | 1982961231 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNN A MINER Project Manager 781-540-9043 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MA DN20604) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN21751) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MA DN11829) | |
| Enumeration Date | 2012-04-11 |
| Last Update Date | 2012-04-11 |