Individual
GARY LI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
158 MAIN ST STE 101, AGAWAM, MA 01001-1803
(413) 728-1500
Mailing address
26 KEMPTON ST, BOSTON, MA 02115-6271
(617) 407-0451
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
DN1859006
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/17/2020
Last updated
07/01/2023
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