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General NPI Number Information
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NPI Number | 1972319481
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Entity Type | Organization
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Legal Business Name | WESTERN MASS PERIODONTICS & IMPLANT SPECIALISTS PC
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 435 SOUTH ST STE 1
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City | PITTSFIELD
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State | MA
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Zip | 01201-8214
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Country | US
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Telephone | 413-445-4592
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Fax |
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Provider Business Mailing Address
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Address Line | 435 SOUTH ST STE 1
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City | PITTSFIELD
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State | MA
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Zip | 01201-8214
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | CHRISTINE BRANIGAN
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Credential |
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Telephone | 631-696-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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