Individual
DR. KEVIN THOMAS BAGNALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
16 HAVERHILL ST, ANDOVER, MA 01810-3002
(978) 475-3997
Mailing address
7 KATHLEEN DR, ANDOVER, MA 01810-1901
(978) 475-3224
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
15888
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
X05575
BCBS ID
MA
Enumeration date
07/03/2006
Last updated
07/08/2007
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