MEDICARE: KRISTEN CHOE DORITY, DMD, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	DN20595	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1518039973	OTHER	MA	DENTAL

General Provider Information

NPI Number	:	1447752563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRISTEN CHOE DORITY, DMD, PC

Provider Business Mailing Address
First Line	:	37 NEWBURY ST STE 3
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02116-3428
Country	:	US
Telephone Number	:	617-416-4685
Fax Number	:

Provider Business Practice Location Address
First Line	:	37 NEWBURY ST STE 3
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02116-3428
Country	:	US
Telephone Number	:	617-426-5549
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KRISTEN DORITY
Credential	:
Telephone Number	:	617-426-5549

Provider Enumeration Date	:	03/05/2018
Last Update Date	:	03/05/2018

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