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General NPI Number Information
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NPI Number | 1679582019
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Entity Type | Individual
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Provider Name | RICHARD MICHAEL GONDEK DMD
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Gender | Male
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1436 MAIN ST
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City | PALMER
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State | MA
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Zip | 01069
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Country | US
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Telephone | 413-283-3360
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Fax |
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Provider Business Mailing Address
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Address Line | 61 WILLIAMS ST
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City | LUDLOW
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State | MA
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Zip | 01056
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Country | US
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Telephone | 413-583-4007
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 15823
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License Number State | MA
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