Provider Demographics
NPI:1710278452
Name:WYCH, KATHRYN KEANE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:KEANE
Last Name:WYCH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ANNE
Other - Last Name:KEANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 PLUMMERS COR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WHITINSVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01588-2135
Mailing Address - Country:US
Mailing Address - Phone:508-234-6634
Mailing Address - Fax:508-234-2552
Practice Address - Street 1:1 PLUMMERS COR
Practice Address - Street 2:SUITE 103
Practice Address - City:WHITINSVILLE
Practice Address - State:MA
Practice Address - Zip Code:01588-2135
Practice Address - Country:US
Practice Address - Phone:508-234-6634
Practice Address - Fax:508-234-2552
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18558811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice