Healthcare Provider Details

I. General information

NPI: 1033422944
Provider Name (Legal Business Name): NEWTON STREET DENTAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 NEWTON ST
SOUTH HADLEY MA
01075-2010
US

IV. Provider business mailing address

488 NEWTON ST
SOUTH HADLEY MA
01075-2010
US

V. Phone/Fax

Practice location:
  • Phone: 413-538-9604
  • Fax: 413-534-3533
Mailing address:
  • Phone: 413-538-9604
  • Fax: 413-534-3533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN20254
License Number StateMA

VIII. Authorized Official

Name: DR. DOUGLAS F LEIGH
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 413-538-9604