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General NPI Number Information
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NPI Number | 1962226589
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Entity Type | Organization
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Legal Business Name | EAST LONGMEADOW DENTAL PLLC
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Dates
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Enumeration Date | 11/11/2024
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 448 N MAIN ST
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City | EAST LONGMEADOW
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State | MA
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Zip | 01028-1861
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Country | US
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Telephone | 617-515-2949
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Fax |
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Provider Business Mailing Address
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Address Line | 10 BIRCHMEADOW DR
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City | HADLEY
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State | MA
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Zip | 01035-3555
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Country | US
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Telephone | 617-515-2949
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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. SETH EICHENLAUB
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Credential | DMD
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Telephone | 617-515-2949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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