=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659871531
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KRAY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2018
-----------------------------------------------------
Last Update Date | 02/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1985 MAIN ST
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01103-1095
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-513-4321
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1985 MAIN ST
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01103-1095
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-513-4321
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. KAVITHA SATHYA
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 617-513-4321
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DN1856292
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------