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General NPI Number Information
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NPI Number | 1972680932
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Entity Type | Organization
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Legal Business Name | KADDIS DENTAL PC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6 DEWEY ST
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City | NATICK
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State | MA
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Zip | 01760
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Country | US
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Telephone | 508-653-3930
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Fax | 508-653-1261
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Provider Business Mailing Address
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Address Line | 6 DEWEY ST
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City | NATICK
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State | MA
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Zip | 01760
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Country | US
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Telephone | 508-653-3930
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Fax | 508-653-1261
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | MINA JOSEPH KADDIS
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Credential |
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Telephone | 508-653-3930
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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 | 21602
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License Number State | MA
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