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General NPI Number Information
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NPI Number | 1083729669
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Entity Type | Individual
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Provider Name | THEODORE S KYTOS DMD
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Gender | Male
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 20 FREMONT ST SUITE 10A
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City | AUXBURY
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State | MA
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Zip | 02332-5338
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Country | US
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Telephone | 781-934-0956
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Fax | 781-934-6859
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Provider Business Mailing Address
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Address Line | 20 FREMONT ST SUITE 10A
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City | AUXBURY
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State | MA
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Zip | 02332-5338
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Country | US
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Telephone | 781-934-0956
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Fax | 781-934-6859
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 14502
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License Number State | MA
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