Provider Demographics
NPI:1891142691
Name:CUDDY, KAYLA (DMD)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:CUDDY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EVERETT ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-3548
Mailing Address - Country:US
Mailing Address - Phone:617-909-3512
Mailing Address - Fax:
Practice Address - Street 1:17 THOMASTON COMMONS WAY
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:ME
Practice Address - Zip Code:04861-3524
Practice Address - Country:US
Practice Address - Phone:844-243-6030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4590122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist