Healthcare Provider Details

I. General information

NPI: 1942649058
Provider Name (Legal Business Name): HILLCREST DENTAL CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 HOSPITAL AVE SUITE 102
NORTH ADAMS MA
01247-2550
US

IV. Provider business mailing address

77 HOSPITAL AVE SUITE 102
NORTH ADAMS MA
01247-2538
US

V. Phone/Fax

Practice location:
  • Phone: 413-346-4242
  • Fax: 413-346-4276
Mailing address:
  • Phone: 413-346-4242
  • Fax: 413-346-4276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. KRISTEN ELCOX
Title or Position: HUMAN RESOURCE MANAGER
Credential:
Phone: 413-445-6680