MEDICARE: DR. DENTAL OF SPRINGFIELD

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	1700910007	MA

General Provider Information

NPI Number	:	1174915474
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. DENTAL OF SPRINGFIELD

Provider Business Mailing Address
First Line	:	1225 LIBERTY ST
Second Line	:	UNIT 3
City	:	SPRINGFIELD
State	:	MA
Zip	:	01104-1165
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1225 LIBERTY ST
Second Line	:	UNIT 3
City	:	SPRINGFIELD
State	:	MA
Zip	:	01104-1165
Country	:	US
Telephone Number	:	413-796-4700
Fax Number	:	413-796-4708

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JULIA FAIGEL
Credential	:
Telephone Number	:	413-796-4700

Provider Enumeration Date	:	02/23/2015
Last Update Date	:	02/23/2015

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