=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962697110
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | N. KENNETH LAMURA, DDS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2007
-----------------------------------------------------
Last Update Date | 10/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 58 MAIN ST
-----------------------------------------------------
City | STURBRIDGE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01566-1507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-347-9503
-----------------------------------------------------
Fax | 508-347-5337
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 58 MAIN ST
-----------------------------------------------------
City | STURBRIDGE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01566-1507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-347-9503
-----------------------------------------------------
Fax | 508-347-5337
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RECEPTIONIST
-----------------------------------------------------
Name | MS. LAURA J PALMER
-----------------------------------------------------
Credential | CDA
-----------------------------------------------------
Telephone | 508-347-9503
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 11756
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------