Individual
KENNY DURANDIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
715 CRESCENT ST STE 9A, BROCKTON, MA 02302-3363
(508) 894-3001
Mailing address
24 WESTHAVEN DR, BROCKTON, MA 02301-1053
(617) 775-1525
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
20386
MA
1223G0001X
General Practice Dentistry
DEN1000580
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0296996
—
MA
Enumeration date
10/11/2006
Last updated
08/20/2007
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