Provider Demographics
NPI:1073239703
Name:KIDS AIRWAY DENTIST, P.C.
Entity Type:Organization
Organization Name:KIDS AIRWAY DENTIST, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDI
Authorized Official - Middle Name:J
Authorized Official - Last Name:EZEKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:978-462-2227
Mailing Address - Street 1:5 HARWICH LN
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-5043
Mailing Address - Country:US
Mailing Address - Phone:617-276-5439
Mailing Address - Fax:
Practice Address - Street 1:7 GRAF RD STE 2A
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-4078
Practice Address - Country:US
Practice Address - Phone:978-462-2227
Practice Address - Fax:978-462-4343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty