Healthcare Provider Details

I. General information

NPI: 1558356311
Provider Name (Legal Business Name): KATHERINE ANNE HALTOM DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 WALNUT ST SUITE 2
FRAMINGHAM MA
01702-7500
US

IV. Provider business mailing address

223 WALNUT ST SUITE 2
FRAMINGHAM MA
01702-7500
US

V. Phone/Fax

Practice location:
  • Phone: 508-879-8004
  • Fax: 508-879-6327
Mailing address:
  • Phone: 508-879-8004
  • Fax: 508-879-6327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number14372
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: