Provider Demographics
NPI:1255539953
Name:KHTITEL DMD PC
Entity type:Organization
Organization Name:KHTITEL DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:HARVEY
Authorized Official - Last Name:TITEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-534-7300
Mailing Address - Street 1:300 LINDEN PONDS WAY
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-3769
Mailing Address - Country:US
Mailing Address - Phone:781-534-7300
Mailing Address - Fax:781-534-7308
Practice Address - Street 1:300 LINDEN PONDS WAY
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-3769
Practice Address - Country:US
Practice Address - Phone:781-534-7300
Practice Address - Fax:781-534-7308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA185721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty