Provider Demographics
NPI:1114366705
Name:SATHYA, KAVITHA (DMD)
Entity type:Individual
Prefix:MS
First Name:KAVITHA
Middle Name:
Last Name:SATHYA
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 STERLING DR # 2
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2249
Mailing Address - Country:US
Mailing Address - Phone:617-513-4321
Mailing Address - Fax:
Practice Address - Street 1:35 NORTHAMPTON ST
Practice Address - Street 2:APT 901
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-513-4321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2025-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18562921223G0001X
CT129451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice