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Individual

KAYLA BETH VASCONCELLOS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DMD

Contact information

Practice address
480 ADAMS ST STE 206, MILTON, MA 02186-4914
(617) 696-5257
Mailing address
100 STATION LNDG UNIT 1005, MEDFORD, MA 02155-5198
(508) 521-4576

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN1859036
MA
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
03/22/2020
Last updated
07/22/2021
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