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General NPI Number Information
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NPI Number | 1750643722
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Entity Type | Organization
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Legal Business Name | CONNECTICUT RIVER VALLEY DENTISTS, PC
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Dates
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Enumeration Date | 06/14/2012
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Last Update Date | 08/28/2012
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Provider Practice Location Address
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Address Line | 138 RUSSELL ST
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City | HADLEY
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State | MA
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Zip | 01035-9533
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Country | US
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Telephone | 413-584-6275
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Fax |
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Provider Business Mailing Address
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Address Line | 138 RUSSELL ST
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City | HADLEY
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State | MA
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Zip | 01035-9533
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Country | US
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Telephone | 413-584-6275
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. SUMEET SAXENA
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Credential | DDS
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Telephone | 973-687-5542
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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 | DN22331
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN22332
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License Number State | MA
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