MEDICARE: ASCENT DENTAL CARE LLC

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

General Provider Information

NPI Number	:	1114492345
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASCENT DENTAL CARE LLC

Provider Business Mailing Address
First Line	:	250 N MAIN ST
Second Line	:
City	:	EAST LONGMEADOW
State	:	MA
Zip	:	01028-1834
Country	:	US
Telephone Number	:	413-224-1493
Fax Number	:	413-224-1746

Provider Business Practice Location Address
First Line	:	250 N MAIN ST
Second Line	:
City	:	EAST LONGMEADOW
State	:	MA
Zip	:	01028-1834
Country	:	US
Telephone Number	:	413-224-1493
Fax Number	:	413-224-1746

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. ANN MARIE SANTOS
Credential	:
Telephone Number	:	413-636-3716

Provider Enumeration Date	:	10/03/2018
Last Update Date	:	10/03/2018

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Directions to “ASCENT DENTAL CARE LLC ” Practice Location

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