Healthcare Provider Details

I. General information

NPI: 1588780126
Provider Name (Legal Business Name): EILEEN KAIN SZYPKO D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 WESTFORD ROAD
CARLISLE MA
01741
US

IV. Provider business mailing address

4 HEATHER DR
WESTFORD MA
01886-3314
US

V. Phone/Fax

Practice location:
  • Phone: 978-369-7967
  • Fax:
Mailing address:
  • Phone: 978-692-4770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number15863
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: