Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 12290 | MA |
NPI | 1083726707 |
---|---|
Provider Name | David Michael Kissell |
First Address | Norwell, MA 02061 |
Second Address | Norwell, MA 02061 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
XO3801KI | BC BS MA (01) | MA |