Provider Demographics
NPI:1053570275
Name:OBARA, KAYOKO (DMD)
Entity type:Individual
Prefix:DR
First Name:KAYOKO
Middle Name:
Last Name:OBARA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 POND AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7141
Mailing Address - Country:US
Mailing Address - Phone:617-739-3326
Mailing Address - Fax:
Practice Address - Street 1:77 POND AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7141
Practice Address - Country:US
Practice Address - Phone:617-739-3326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18242122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty