Organization
AESTHETIC SMILE RECONSTRUCTION PC
Active
Other names
Aesthetic Smile Reconstruction
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES SUTERA III DMD (PRESIDENT)
(978) 314-8974
Entity
Organization
Contact information
Practice address
75 3RD AVE STE 1B, WALTHAM, MA 02451-7549
(781) 487-1111
Mailing address
20 ROOSEVELT RD, MEDFORD, MA 02155-2519
(978) 314-8974
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
12/18/2018
Last updated
12/18/2018
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