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General NPI Number Information
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NPI Number | 1952089658
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Entity Type | Individual
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Provider Name | LETICIA KLOS D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/11/2023
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Last Update Date | 07/11/2023
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Provider Practice Location Address
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Address Line | 1300 UNION ST
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City | WESTBOROUGH
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State | MA
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Zip | 01581-5416
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Country | US
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Telephone | 508-366-3623
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Fax |
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Provider Business Mailing Address
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Address Line | 13 LILIAN ROAD EXT
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City | FRAMINGHAM
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State | MA
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Zip | 01701-4822
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Country | US
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Telephone | 508-505-7552
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN1859855
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License Number State | MA
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