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General NPI Number Information
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NPI Number | 1881076560
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Entity Type | Organization
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Legal Business Name | DIKE KENNETH
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Dates
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Enumeration Date | 06/18/2015
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Last Update Date | 06/18/2015
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Provider Practice Location Address
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Address Line | 15 BERGERON WAY
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City | STOUGHTON
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State | MA
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Zip | 02072-1392
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Country | US
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Telephone | 508-631-8222
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Fax |
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Provider Business Mailing Address
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Address Line | 15 BERGERON WAY
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City | STOUGHTON
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State | MA
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Zip | 02072
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Country | US
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Telephone | 617-967-2115
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Fax |
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Authorized Official
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Title or Position | LPN
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Name | KENNETH DAVID DIKE
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Credential | LPN
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Telephone | 508-631-8222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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