Provider Demographics
NPI:1538129978
Name:KASHMANIAN, JOHN R (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:KASHMANIAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:55 EVERETT STREET
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550
Mailing Address - Country:US
Mailing Address - Phone:508-765-0099
Mailing Address - Fax:508-765-0091
Practice Address - Street 1:55 EVERETT STREET
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550
Practice Address - Country:US
Practice Address - Phone:508-765-0099
Practice Address - Fax:508-765-0091
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA0016765204E00000X
CT007615204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
12207OtherFALLON COMMUNITY HEALTH P
792734OtherUNITED CONCORDIA
368390OtherCIGNA
MA682OtherDELTA DENTAL MA
MA0273147Medicaid
754041OtherTUFTS HEALTH PLAN
MAX06293OtherBCBS MEDICAL AND DENTAL
16531OtherHARVARD PILGRIM HEALTHCAR
MA983782OtherNETWORK HEALTH