Healthcare Provider Details

I. General information

NPI: 1952968729
Provider Name (Legal Business Name): HAMPSHIRE MEADOW FAMILY & PEDIATRIC DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 RUSSELL ST APT 18
HADLEY MA
01035-5907
US

IV. Provider business mailing address

207 RUSSELL ST APT 18
HADLEY MA
01035-5907
US

V. Phone/Fax

Practice location:
  • Phone: 413-387-4636
  • Fax:
Mailing address:
  • Phone: 413-387-4636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. NOELLE NUBANI
Title or Position: CEO
Credential: DMD
Phone: 617-669-6925