Healthcare Provider Details

I. General information

NPI: 1225170772
Provider Name (Legal Business Name): SUSAN M PLOURDE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 SPRINGFIELD STREET
FEEDING HILLS MA
01030
US

IV. Provider business mailing address

532 SPRINGFIELD STREET
FEEDING HILLS MA
01030
US

V. Phone/Fax

Practice location:
  • Phone: 413-789-0134
  • Fax: 413-789-0467
Mailing address:
  • Phone: 413-789-0134
  • Fax: 413-789-0467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14334
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: