Healthcare Provider Details

I. General information

NPI: 1235448945
Provider Name (Legal Business Name): KD ORTHODONTICS P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 PARK ST
WEST SPRINGFIELD MA
01089-3314
US

IV. Provider business mailing address

232 PARK ST
WEST SPRINGFIELD MA
01089-3314
US

V. Phone/Fax

Practice location:
  • Phone: 413-737-2200
  • Fax:
Mailing address:
  • Phone: 413-737-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number19482
License Number StateMA

VIII. Authorized Official

Name: DR. ROBERT L MATTHEWS
Title or Position: OWNER
Credential: DMD
Phone: 413-737-2200