Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 15807 | MA |
NPI | 1013040039 |
---|---|
Provider Name | Dr. Jeffrey B Kravitz |
First Address | Wakefield, MA 01880-3516 |
Second Address | Wakefield, MA 01880-3516 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 08/07/2007 |