Healthcare Provider Details

I. General information

NPI: 1851150866
Provider Name (Legal Business Name): SPRINGFIELD KIDS DENTIST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 03/14/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 ALLEN ST
SPRINGFIELD MA
01118-1817
US

IV. Provider business mailing address

9 WILLOW WOODS DR
SHREWSBURY MA
01545-6043
US

V. Phone/Fax

Practice location:
  • Phone: 413-295-1600
  • Fax: 413-295-1610
Mailing address:
  • Phone: 857-284-6358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. NIDHI AGARWAL
Title or Position: OWNER
Credential: DMD
Phone: 857-284-6358