Healthcare Provider Details

I. General information

NPI: 1750643722
Provider Name (Legal Business Name): CONNECTICUT RIVER VALLEY DENTISTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 08/28/2012
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
HADLEY MA
01035-9533
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN22331
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN22332
License Number StateMA

VIII. Authorized Official

Name: DR. SUMEET SAXENA
Title or Position: DIRECTOR
Credential: DDS
Phone: 973-687-5542