Provider Demographics
NPI:1861807513
Name:WYCH FAMILY DENTAL, PC
Entity type:Organization
Organization Name:WYCH FAMILY DENTAL, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:KEANE
Authorized Official - Last Name:WYCH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-234-6634
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18558811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty