Healthcare Provider Details

I. General information

NPI: 1891142691
Provider Name (Legal Business Name): KAYLA CUDDY DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 THOMASTON COMMONS WAY
THOMASTON ME
04861-3524
US

IV. Provider business mailing address

1 EVERETT ST
DORCHESTER MA
02122-3548
US

V. Phone/Fax

Practice location:
  • Phone: 844-243-6030
  • Fax:
Mailing address:
  • Phone: 617-909-3512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN4590
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: