Healthcare Provider Details

I. General information

NPI: 1225567357
Provider Name (Legal Business Name): ERIC NAG BUM CHU DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: NAG BUM CHU DMD

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 NEWTON ST STE 1
SOUTH HADLEY MA
01075-2010
US

IV. Provider business mailing address

659 PROSPECT ST APT B1
CHICOPEE MA
01020-3047
US

V. Phone/Fax

Practice location:
  • Phone: 413-538-9604
  • Fax: 413-534-3533
Mailing address:
  • Phone: 217-766-2038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1857535
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: