MEDICARE: UNITY DENTAL SPRINGFIELD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1578259909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITY DENTAL SPRINGFIELD PC

Provider Business Mailing Address
First Line	:	161 PENWOOD XING
Second Line	:
City	:	GLASTONBURY
State	:	CT
Zip	:	06033-2756
Country	:	US
Telephone Number	:	617-816-1759
Fax Number	:

Provider Business Practice Location Address
First Line	:	1178 PARKER ST
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01129-1030
Country	:	US
Telephone Number	:	617-816-1759
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TARAKESWAR REDDY VONGURU
Credential	:	DDS
Telephone Number	:	617-816-1759

Provider Enumeration Date	:	04/18/2023
Last Update Date	:	04/18/2023

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