Healthcare Provider Details

I. General information

NPI: 1013022672
Provider Name (Legal Business Name): METHEN DENTAL SPECIALTY ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 EAST STREETSUITE 3200
METHVEN MA
01844
US

IV. Provider business mailing address

60 EAST STREET SUITE 3200
METHVEN MA
01844
US

V. Phone/Fax

Practice location:
  • Phone: 978-685-2471
  • Fax: 978-683-3985
Mailing address:
  • Phone: 978-685-2471
  • Fax: 978-683-3985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number18533
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number20469
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number16114
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. HOWARD W SMITH
Title or Position: CLERK
Credential:
Phone: 978-685-2471