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General NPI Number Information
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NPI Number | 1942792379
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Entity Type | Individual
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Provider Name | KATHLEEN TAKACH DMD, MPH
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Gender | Female
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Dates
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Enumeration Date | 06/01/2018
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Last Update Date | 04/05/2023
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Provider Practice Location Address
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Address Line | 326 NICHOLS RD
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City | FITCHBURG
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State | MA
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Zip | 01420-1914
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Country | US
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Telephone | 978-878-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 20 MORGAN DR UNIT 35
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City | LEBANON
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State | NH
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Zip | 03766-1484
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Country | US
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Telephone | 207-253-9434
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN.00205494
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 04407
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License Number State | NH
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN1858901
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License Number State | MA
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