Individual
MISS IMAN TYERRA KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
720 WASHINGTON ST, ATTLEBORO, MA 02703-6948
(704) 355-2165
Mailing address
3 DOLORES AVE APT 1, WALTHAM, MA 02452-4918
(704) 614-9641
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
57000026
NC
122300000X
Dentist
Primary
DN1858174
MA
Other
Enumeration date
03/28/2016
Last updated
03/26/2019
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