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General NPI Number Information
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NPI Number | 1417162918
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Entity Type | Organization
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Legal Business Name | THE KIDS DENTIST
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 232 PARK ST
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City | WEST SPRINGFIELD
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State | MA
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Zip | 01089-3314
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Country | US
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Telephone | 413-737-2200
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Fax | 413-746-8581
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Provider Business Mailing Address
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Address Line | 232 PARK STREET
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City | WEST SPRINGFIELD
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State | MA
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Zip | 01089-3314
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Country | US
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Telephone | 413-737-2200
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Fax | 413-746-8581
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT L MATTHEWS
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Credential | DMD
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 19482
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License Number State | MA
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