Provider Demographics
NPI:1659387983
Name:MAGUIRE, KERRY (DDS MSPH)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:
Last Name:MAGUIRE
Suffix:
Gender:F
Credentials:DDS MSPH
Other - Prefix:DR
Other - First Name:KERRY
Other - Middle Name:MAGUIRE
Other - Last Name:ELA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:12 BLAKE ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478
Mailing Address - Country:US
Mailing Address - Phone:617-489-1299
Mailing Address - Fax:617-489-1736
Practice Address - Street 1:12 BLAKE ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478
Practice Address - Country:US
Practice Address - Phone:617-489-1299
Practice Address - Fax:617-489-1736
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204581223G0001X
CO65771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice