Individual
KEITH THOMAS MIELKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1 KNEELAND ST, BOSTON, MA 02111-1527
(760) 696-2850
Mailing address
665 WASHINGTON ST UNIT 913, BOSTON, MA 02111-1641
(760) 696-2850
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN1859788
MA
Other
Enumeration date
06/16/2023
Last updated
06/16/2023
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