Healthcare Provider Details

I. General information

NPI: 1609865849
Provider Name (Legal Business Name): PETER G. CINNER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 RUSSELL ST
HADLEY MA
01035-9533
US

IV. Provider business mailing address

138 RUSSELL ST P.O. BOX 408
HADLEY MA
01035-9533
US

V. Phone/Fax

Practice location:
  • Phone: 413-584-6275
  • Fax: 413-584-5938
Mailing address:
  • Phone: 413-584-6275
  • Fax: 413-584-5938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11754
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: