Healthcare Provider Details

I. General information

NPI: 1164711651
Provider Name (Legal Business Name): DENTAL CLINIC AT THE HOLYOKE VETERANS HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CHERRY ST
HOLYOKE MA
01040-7002
US

IV. Provider business mailing address

230 MAPLE ST
HOLYOKE MA
01040-5144
US

V. Phone/Fax

Practice location:
  • Phone: 413-420-6270
  • Fax: 413-536-6272
Mailing address:
  • Phone: 413-420-2122
  • Fax: 413-539-9472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number4118
License Number StateMA

VIII. Authorized Official

Name: REGINA BOK
Title or Position: CFO
Credential:
Phone: 413-420-2123