Healthcare Provider Details

I. General information

NPI: 1164565016
Provider Name (Legal Business Name): CAPITAL AREA HUDSON VALLEY NEW YORK DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

489 BERNARDSTON RD STE 206
GREENFIELD MA
01301-1239
US

IV. Provider business mailing address

489 BERNARDSTON RD STE 206
GREENFIELD MA
01301-1239
US

V. Phone/Fax

Practice location:
  • Phone: 413-773-3850
  • Fax: 413-773-5300
Mailing address:
  • Phone: 413-773-3850
  • Fax: 413-773-5300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CELIA HAYES
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 217-540-2100