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General NPI Number Information
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NPI Number | 1174583512
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Entity Type | Organization
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Legal Business Name | JOHN R KASHMANIAN DMD INC
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Dates
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Enumeration Date | 03/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 55 EVERETT ST
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City | SOUTHBRIDGE
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State | MA
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Zip | 01550
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Country | US
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Telephone | 508-765-0099
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Fax | 508-765-0091
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Provider Business Mailing Address
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Address Line | 55 EVERETT ST
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City | SOUTHBRIDGE
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State | MA
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Zip | 01550
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Country | US
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Telephone | 508-765-0099
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Fax | 508-765-0091
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN R KASHMANIAN
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Credential | DMD
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Telephone | 508-765-0099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 0016765
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License Number State | MA
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