Provider Demographics
NPI:1063545440
Name:POWERS, DANA KELLY (DDS)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:KELLY
Last Name:POWERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:K
Other - Last Name:POWERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, PC
Mailing Address - Street 1:41 VINE ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01944-1143
Mailing Address - Country:US
Mailing Address - Phone:978-526-7707
Mailing Address - Fax:978-526-1051
Practice Address - Street 1:41 VINE ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01944-1143
Practice Address - Country:US
Practice Address - Phone:978-526-7707
Practice Address - Fax:978-526-1051
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA178481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice