Healthcare Provider Details

I. General information

NPI: 1710360052
Provider Name (Legal Business Name): MICHAEL MOHR D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2015
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 ADAMS RD
WILLIAMSTOWN MA
01267-2931
US

IV. Provider business mailing address

172 ADAMS RD
WILLIAMSTOWN MA
01267-2931
US

V. Phone/Fax

Practice location:
  • Phone: 413-458-8102
  • Fax: 413-458-3248
Mailing address:
  • Phone: 413-458-8102
  • Fax: 413-458-3248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number058495
License Number StateMA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: