MEDICARE: PHILIP C. IRVING,DDS,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	12970	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356461891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILIP C. IRVING,DDS,PC

Provider Business Mailing Address
First Line	:	1383 MAIN ST
Second Line	:	SUITE 301
City	:	SPRINGFIELD
State	:	MA
Zip	:	01103-1653
Country	:	US
Telephone Number	:	413-737-3700
Fax Number	:	413-736-6515

Provider Business Practice Location Address
First Line	:	1383 MAIN ST
Second Line	:	SUITE 301
City	:	SPRINGFIELD
State	:	MA
Zip	:	01103-1653
Country	:	US
Telephone Number	:	413-737-3700
Fax Number	:	413-736-6515

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PHILIP CRAIG IRVING
Credential	:	DDS
Telephone Number	:	413-737-3700

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	08/22/2020

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