MEDICARE: PRECISION DENTAL ASSOCIATES 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	14542	MA

General Provider Information

NPI Number	:	1659675023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRECISION DENTAL ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	190 RUSSELL ST
Second Line	:
City	:	HADLEY
State	:	MA
Zip	:	01035-9542
Country	:	US
Telephone Number	:	413-586-3306
Fax Number	:

Provider Business Practice Location Address
First Line	:	190 RUSSELL ST
Second Line	:
City	:	HADLEY
State	:	MA
Zip	:	01035-9542
Country	:	US
Telephone Number	:	413-586-3306
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARK M KLEPACKI
Credential	:	DMD
Telephone Number	:	413-586-3306

Provider Enumeration Date	:	12/29/2010
Last Update Date	:	12/29/2010

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