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General NPI Number Information
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NPI Number | 1104180439
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Entity Type | Individual
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Provider Name | KHUSHBOO D TALATI DDS
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Gender | Female
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Dates
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Enumeration Date | 07/02/2012
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Last Update Date | 01/15/2016
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Provider Practice Location Address
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Address Line | 315 CENTRE ST
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City | JAMAICA PLAIN
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State | MA
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Zip | 02130-1414
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Country | US
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Telephone | 508-559-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 826 WILLARD ST APT#117
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City | QUINCY
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State | MA
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Zip | 02169-7453
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Country | US
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Telephone | 201-286-0288
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN1856069
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License Number State | MA
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