Healthcare Provider Details

I. General information

NPI: 1144247057
Provider Name (Legal Business Name): STUART H SANDREW DDS MSD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 SOUTH STREET
PITTSFIELD MA
01201
US

IV. Provider business mailing address

435 SOUTH STREET
PITTSFIELD MA
01201
US

V. Phone/Fax

Practice location:
  • Phone: 413-445-4592
  • Fax: 413-445-6756
Mailing address:
  • Phone: 413-445-4592
  • Fax: 413-445-6756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number10127
License Number StateMA

VIII. Authorized Official

Name: DR. STUART HOWARD SANDREW
Title or Position: PRESIDENT
Credential: DDS MSD
Phone: 413-445-4592