MEDICARE: 16 ACRES DENTAL HEALTH CENTER, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	18712	MA

General Provider Information

NPI Number	:	1043338817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	16 ACRES DENTAL HEALTH CENTER, PC

Provider Business Mailing Address
First Line	:	1178 PARKER ST
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01129-1030
Country	:	US
Telephone Number	:	413-783-5787
Fax Number	:	413-783-4577

Provider Business Practice Location Address
First Line	:	1178 PARKER ST
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01129-1030
Country	:	US
Telephone Number	:	413-783-5787
Fax Number	:	413-783-4577

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. YEN-CHENG LAI
Credential	:	D.M.D.
Telephone Number	:	413-783-5787

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	08/22/2020

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