Healthcare Provider Details

I. General information

NPI: 1881758159
Provider Name (Legal Business Name): GERARD KUGEL D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 COMMONWEALTH AVE
BOSTON MA
02215-2813
US

IV. Provider business mailing address

400 COMMONWEALTH AVE
BOSTON MA
02215-2813
US

V. Phone/Fax

Practice location:
  • Phone: 617-536-4620
  • Fax: 617-536-3872
Mailing address:
  • Phone: 617-536-4620
  • Fax: 617-536-3872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number16126
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: