Provider Demographics
NPI:1851849780
Name:KAVASH, KATE
Entity Type:Individual
Prefix:MS
First Name:KATE
Middle Name:
Last Name:KAVASH
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KATE
Other - Middle Name:KAVASH
Other - Last Name:RUSSO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDH
Mailing Address - Street 1:153 MANCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5142
Mailing Address - Country:US
Mailing Address - Phone:603-224-9474
Mailing Address - Fax:
Practice Address - Street 1:153 MANCHESTER ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5142
Practice Address - Country:US
Practice Address - Phone:603-224-9474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH02015124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist