Provider Demographics
NPI:1083729669
Name:KYTOS, THEODORE S (DMD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:S
Last Name:KYTOS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 FREMONT ST
Mailing Address - Street 2:SUITE 10A
Mailing Address - City:AUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-5338
Mailing Address - Country:US
Mailing Address - Phone:781-934-0956
Mailing Address - Fax:781-934-6859
Practice Address - Street 1:20 FREMONT ST
Practice Address - Street 2:SUITE 10A
Practice Address - City:AUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-5338
Practice Address - Country:US
Practice Address - Phone:781-934-0956
Practice Address - Fax:781-934-6859
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA145021223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics