Provider Demographics
NPI:1487215257
Name:MASCARDO, KATHLEEN CHLOE MARGAJA (DMD, MMSC)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN CHLOE
Middle Name:MARGAJA
Last Name:MASCARDO
Suffix:
Gender:F
Credentials:DMD, MMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BROOKLINE AVENUE UNIT 707
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:805-710-3611
Mailing Address - Fax:
Practice Address - Street 1:682 DEPOT ST SUITE A
Practice Address - Street 2:
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-5819
Practice Address - Country:US
Practice Address - Phone:508-586-6002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2023-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103820122300000X
MA103820122300000X
MADN18585831223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist