Provider Demographics
NPI:1104029974
Name:EKLUND, KATHY J (RDH MHP)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:J
Last Name:EKLUND
Suffix:
Gender:F
Credentials:RDH MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 FENWAY
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-3782
Mailing Address - Country:US
Mailing Address - Phone:617-892-8216
Mailing Address - Fax:
Practice Address - Street 1:140 FENWAY
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-3782
Practice Address - Country:US
Practice Address - Phone:617-892-8216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7583124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7583OtherMA LICENSE # FOR RDH