MEDICARE: MURABIA FAMILY DENTAL LLC

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	:	1801490537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MURABIA FAMILY DENTAL LLC

Provider Business Mailing Address
First Line	:	2117 CANYON RIDGE DR
Second Line	:
City	:	BROAD BROOK
State	:	CT
Zip	:	06016-5618
Country	:	US
Telephone Number	:	929-484-7828
Fax Number	:

Provider Business Practice Location Address
First Line	:	436 CHICOPEE ST
Second Line	:
City	:	CHICOPEE
State	:	MA
Zip	:	01013-1941
Country	:	US
Telephone Number	:	929-484-7828
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	PRABHJOT SINGH
Credential	:	DDS
Telephone Number	:	929-484-7828

Provider Enumeration Date	:	11/23/2020
Last Update Date	:	11/23/2020

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