Organization
PROFESSIONAL DENTAL IMAGE CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUAN JOSE GRAHAM DMD (PRESIDENT)
(617) 924-6422
Entity
Organization
Contact information
Practice address
53 BIGELOW AVE, WATERTOWN, MA 02472
(617) 924-6422
(617) 924-6422
Mailing address
53 BIGELOW AVE, WATERTOWN, MA 02472
(617) 924-6422
(617) 924-6422
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
18068
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9786139
—
MA
Enumeration date
09/13/2006
Last updated
08/22/2020
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