Healthcare Provider Details

I. General information

NPI: 1275912339
Provider Name (Legal Business Name): MATTHEWS PCC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2015
Last Update Date: 05/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1984 BOSTON RD
WILBRAHAM MA
01095-1046
US

IV. Provider business mailing address

68 BAIRDCREST RD
SPRINGFIELD MA
01118-1757
US

V. Phone/Fax

Practice location:
  • Phone: 413-737-2200
  • Fax:
Mailing address:
  • Phone: 413-783-3621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDN1856880
License Number StateMA

VIII. Authorized Official

Name: DR. ROBERT MATTHEWS
Title or Position: OWNER
Credential: D.M.D
Phone: 413-737-2200