Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 14502 | MA |
NPI | 1083729669 |
---|---|
Provider Name | Theodore S Kytos |
First Address | Auxbury, MA 02332-5338 |
Second Address | Auxbury, MA 02332-5338 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 08/07/2007 |