Healthcare Provider Details

I. General information

NPI: 1689711509
Provider Name (Legal Business Name): NATICK DENTAL PARTNERS LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 POND STREET
NATICK MA
01760
US

IV. Provider business mailing address

230 POND STREET
NATICK MA
01760
US

V. Phone/Fax

Practice location:
  • Phone: 508-653-2417
  • Fax: 508-650-5715
Mailing address:
  • Phone: 508-653-2417
  • Fax: 508-650-5715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number12919
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12607
License Number StateMA

VIII. Authorized Official

Name: JAMES FRANCIS KANE III
Title or Position: PARTNER/ORTHODONTIST
Credential: DMD
Phone: 508-653-2417