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General NPI Number Information
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NPI Number | 1255539953
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Entity Type | Organization
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Legal Business Name | KHTITEL DMD PC
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Dates
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Enumeration Date | 07/05/2007
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Last Update Date | 09/06/2007
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Provider Practice Location Address
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Address Line | 300 LINDEN PONDS WAY
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City | HINGHAM
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State | MA
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Zip | 02043-3769
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Country | US
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Telephone | 781-534-7300
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Fax | 781-534-7308
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Provider Business Mailing Address
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Address Line | 300 LINDEN PONDS WAY
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City | HINGHAM
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State | MA
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Zip | 02043-3769
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Country | US
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Telephone | 781-534-7300
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Fax | 781-534-7308
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH HARVEY TITEL
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Credential | DMD
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Telephone | 781-534-7300
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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 | 18572
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License Number State | MA
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