Healthcare Provider Details

I. General information

NPI: 1942400361
Provider Name (Legal Business Name): KIRAN SANJAY NAIK D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HIGH ST
CLINTON MA
01510
US

IV. Provider business mailing address

650 LINCOLN ST
WORCESTER MA
01605-2060
US

V. Phone/Fax

Practice location:
  • Phone: 978-368-0340
  • Fax: 978-368-1719
Mailing address:
  • Phone: 508-854-2122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDL12367
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDL13561
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: