Healthcare Provider Details

I. General information

NPI: 1801936570
Provider Name (Legal Business Name): WESTERN MASS ENDODONTICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 LIBERTY STREET WESTERN MASS ENDODONTICS
SPRINGFIELD MA
01103
US

IV. Provider business mailing address

15 LIBERTY STREET WESTERN MASS ENDODONTICS
SPRINGFIELD MA
01103
US

V. Phone/Fax

Practice location:
  • Phone: 413-733-6600
  • Fax: 413-732-1667
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. SHAWN M RECORD
Title or Position: PRESIDENT CORPORATION
Credential: DMD
Phone: 413-733-6600