Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 18507 | MA |
NPI | 1093885691 |
---|---|
Provider Name | Dr. Kenneth A Macafee II |
First Address | Waltham, MA 02451-7404 |
Second Address | Waltham, MA 02451-7404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2006 |
Last Update Date | 08/07/2007 |