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General NPI Number Information
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NPI Number | 1447442090
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Entity Type | Individual
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Provider Name | LUZIA GRACE GONCALVES R.D.H.
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Gender | Female
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Dates
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Enumeration Date | 08/16/2007
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Last Update Date | 10/22/2007
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Provider Practice Location Address
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Address Line | 91 E MOUNTAIN RD
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City | WESTFIELD
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State | MA
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Zip | 01085-1801
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Country | US
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Telephone | 413-562-4131
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Fax |
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Provider Business Mailing Address
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Address Line | 43 WATSON LN
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City | LUDLOW
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State | MA
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Zip | 01056-1750
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Country | US
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Telephone | 413-610-0159
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 11898
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License Number State | MA
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