MEDICARE: SOUTH HADLEY DENTAL ASSOCIATES, INC.

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	17568	MA

General Provider Information

NPI Number	:	1538283635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH HADLEY DENTAL ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	15 DAYTON ST
Second Line	:
City	:	SOUTH HADLEY
State	:	MA
Zip	:	01075-1924
Country	:	US
Telephone Number	:	413-536-4455
Fax Number	:	413-532-1757

Provider Business Practice Location Address
First Line	:	15 DAYTON ST
Second Line	:
City	:	SOUTH HADLEY
State	:	MA
Zip	:	01075-1924
Country	:	US
Telephone Number	:	413-536-4455
Fax Number	:	413-532-1757

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARJORIE BLOCK
Credential	:	DMD
Telephone Number	:	413-536-4455

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	08/22/2020

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