Provider Demographics
NPI:1306569876
Name:CABOT, KSENIIA ANDREEVNA
Entity type:Individual
Prefix:DR
First Name:KSENIIA
Middle Name:ANDREEVNA
Last Name:CABOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FOXFIRE DR
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-2804
Mailing Address - Country:US
Mailing Address - Phone:978-505-6575
Mailing Address - Fax:
Practice Address - Street 1:15 BRYANT ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-4401
Practice Address - Country:US
Practice Address - Phone:781-326-1078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18596191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice