Healthcare Provider Details

I. General information

NPI: 1528414679
Provider Name (Legal Business Name): KUNAL VASANT DANI D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2016
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 DEAN ST
TAUNTON MA
02780-2716
US

IV. Provider business mailing address

2910 WINDSOR RIDGE DR
WESTBOROUGH MA
01581-2360
US

V. Phone/Fax

Practice location:
  • Phone: 352-215-7050
  • Fax:
Mailing address:
  • Phone: 352-215-7050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN1857238
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: