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General NPI Number Information
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NPI Number | 1982932315
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Entity Type | Organization
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Legal Business Name | LISA B. EMIRZIAN DMD & ASSOCIATES
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Dates
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Enumeration Date | 11/23/2009
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Last Update Date | 11/23/2009
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Provider Practice Location Address
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Address Line | 64 GOTHIC ST
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City | NORTHAMPTON
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State | MA
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Zip | 01060-3042
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Country | US
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Telephone | 413-584-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 16 GERRARD AVE
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City | EAST LONGMEADOW
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State | MA
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Zip | 01028-1606
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Country | US
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Telephone | 413-731-8814
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Fax |
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | COLLEEN NADEAU
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Credential |
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Telephone | 413-731-8814
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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 | 15280
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License Number State | MA
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