MEDICARE: DR. KATHLEEN CHLOE MARGAJA MASCARDO DMD, MMSC

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	122300000X	Dentist	103820	CA
2	122300000X	Dentist	103820	MA
3	1223P0300X	Periodontics	DN1858583	MA

General Provider Information

NPI Number	:	1487215257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN CHLOE MARGAJA MASCARDO DMD, MMSC

Provider Business Mailing Address
First Line	:	200 BROOKLINE AVENUE UNIT 707
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02215
Country	:	US
Telephone Number	:	805-710-3611
Fax Number	:

Provider Business Practice Location Address
First Line	:	682 DEPOT ST SUITE A
Second Line	:
City	:	NORTH EASTON
State	:	MA
Zip	:	02356-5819
Country	:	US
Telephone Number	:	508-586-6002
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2019
Last Update Date	:	06/25/2023

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