Provider Demographics
NPI:1477992840
Name:THIND, KANCHAN (DMD)
Entity Type:Individual
Prefix:
First Name:KANCHAN
Middle Name:
Last Name:THIND
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MIDDLESEX AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-1102
Mailing Address - Country:US
Mailing Address - Phone:617-764-1781
Mailing Address - Fax:617-764-5649
Practice Address - Street 1:5 MIDDLESEX AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-1102
Practice Address - Country:US
Practice Address - Phone:617-764-1781
Practice Address - Fax:617-764-5649
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18562981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice