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General NPI Number Information
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NPI Number | 1275912339
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Entity Type | Organization
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Legal Business Name | MATTHEWS PCC LLC
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Dates
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Enumeration Date | 05/22/2015
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Last Update Date | 05/22/2015
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Provider Practice Location Address
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Address Line | 1984 BOSTON RD
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City | WILBRAHAM
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State | MA
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Zip | 01095-1046
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Country | US
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Telephone | 413-737-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 68 BAIRDCREST RD
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City | SPRINGFIELD
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State | MA
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Zip | 01118-1757
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Country | US
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Telephone | 413-783-3621
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT MATTHEWS
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Credential | D.M.D
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Telephone | 413-737-2200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN1856880
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License Number State | MA
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