Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DN1855348 | MA |
Y | 1223P0700X | Prosthodontist | DN1855348 | MA |
NPI | 1063675494 |
---|---|
Provider Name | Dr. Theodoros Kapos |
First Address | Roxbury Crossing, MA 02120-1677 |
Second Address | Boston, MA 02115-5819 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2008 |
Last Update Date | 11/08/2010 |