Individual
KYLE PROHOVICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DR.
Contact information
Practice address
9 FAITH RD, WINDHAM, NH 03087-1554
(617) 335-2650
Mailing address
9 FAITH RD, WINDHAM, NH 03087-1554
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DN1857947
MA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/30/2018
Last updated
10/30/2018
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