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General NPI Number Information
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NPI Number | 1982362638
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Entity Type | Organization
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Legal Business Name | MAPLE STREET DENTAL PLLC
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Dates
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Enumeration Date | 11/30/2021
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Last Update Date | 11/30/2021
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Provider Practice Location Address
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Address Line | 813 WILLIAMS ST STE 207
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City | LONGMEADOW
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State | MA
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Zip | 01106-2052
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Country | US
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Telephone | 413-567-1223
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Fax |
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Provider Business Mailing Address
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Address Line | 5 CAMPUS LN
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City | EASTHAMPTON
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State | MA
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Zip | 01027-1429
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Country | US
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Telephone | 617-515-2949
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Fax | 413-527-1242
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Authorized Official
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Title or Position | PRESIDENT
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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 | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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