Healthcare Provider Details

I. General information

NPI: 1861094021
Provider Name (Legal Business Name): ROSA IRENY SALDANA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 OLD NORTH RD
WORTHINGTON MA
01098-9708
US

IV. Provider business mailing address

80 CHAPIN TER
SPRINGFIELD MA
01107-1706
US

V. Phone/Fax

Practice location:
  • Phone: 413-238-5511
  • Fax:
Mailing address:
  • Phone: 646-228-9714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDL14619
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: