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General NPI Number Information
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NPI Number | 1245013564
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Entity Type | Organization
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Legal Business Name | MOBILE DENTAL HYGIENE SERVICES OF WESTERN MASS, LLC
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Dates
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Enumeration Date | 08/18/2023
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Last Update Date | 08/18/2023
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Provider Practice Location Address
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Address Line | 359 BROOKFIELD RD
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City | BRIMFIELD
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State | MA
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Zip | 01010-9676
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Country | US
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Telephone | 508-341-1599
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 103
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City | BRIMFIELD
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State | MA
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Zip | 01010-0103
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Country | US
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Telephone | 508-341-1599
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Fax |
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Authorized Official
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Title or Position | REGISTERED DENTAL HYGIENIST
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Name | MS. MANDA LEE DAY
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Credential | RDH
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Telephone | 508-341-1599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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