Provider Demographics
NPI:1104180439
Name:TALATI, KHUSHBOO D (DDS)
Entity Type:Individual
Prefix:MRS
First Name:KHUSHBOO
Middle Name:D
Last Name:TALATI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:KHUSHBOO
Other - Middle Name:D
Other - Last Name:TALATI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:826 WILLARD ST
Mailing Address - Street 2:APT#117
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7453
Mailing Address - Country:US
Mailing Address - Phone:201-286-0288
Mailing Address - Fax:
Practice Address - Street 1:315 CENTRE ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-1414
Practice Address - Country:US
Practice Address - Phone:508-559-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18560691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice