=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598541641
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSPHAT NJOROGE NDEGWA RDH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2023
-----------------------------------------------------
Last Update Date | 09/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 354 WAVERLEY ST
-----------------------------------------------------
City | FRAMINGHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01702-7079
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-852-1805
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 47 PRINCETON ST APT 304
-----------------------------------------------------
City | LEOMINSTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01453-1423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-714-1027
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | DH90897
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------