Healthcare Provider Details

I. General information

NPI: 1669960027
Provider Name (Legal Business Name): NEW ENGLAND FAMILY DENTISTRY ,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 COOLEY ST
SPRINGFIELD MA
01128-1144
US

IV. Provider business mailing address

5 MOUNT ROYAL AVE STE 300
MARLBOROUGH MA
01752-1900
US

V. Phone/Fax

Practice location:
  • Phone: 413-796-1616
  • Fax: 413-796-1617
Mailing address:
  • Phone: 508-460-0632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number1857191
License Number StateMA

VIII. Authorized Official

Name: LISA J CHOINIERE
Title or Position: BILLING MANAGER
Credential:
Phone: 508-460-0632