MEDICARE: NAZLI IDIL KACAMAK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	05259	NH

General Provider Information

NPI Number	:	1487332847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAZLI IDIL KACAMAK

Provider Business Mailing Address
First Line	:	1 KNEELAND ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02111-1527
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 CRYSTAL AVE
Second Line	:
City	:	DERRY
State	:	NH
Zip	:	03038-2413
Country	:	US
Telephone Number	:	603-437-0331
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2023
Last Update Date	:	08/07/2025

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Directions to “ NAZLI IDIL KACAMAK ” Practice Location

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