Provider Demographics
NPI:1477920098
Name:KAYOKO OBARA, DMD PC
Entity Type:Organization
Organization Name:KAYOKO OBARA, DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAYOKO
Authorized Official - Middle Name:
Authorized Official - Last Name:OBARA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-566-1717
Mailing Address - Street 1:77 POND AVE.
Mailing Address - Street 2:#103
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445
Mailing Address - Country:US
Mailing Address - Phone:617-566-1717
Mailing Address - Fax:617-739-3326
Practice Address - Street 1:77 POND AVE.
Practice Address - Street 2:#103
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445
Practice Address - Country:US
Practice Address - Phone:617-566-1717
Practice Address - Fax:617-739-3326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18242261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental