MEDICARE: ELLEN J SPIELBERG DMD

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	17014	MA

General Provider Information

NPI Number	:	1740369024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN J SPIELBERG DMD

Provider Business Mailing Address
First Line	:	1655 BOSTON RD
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01129-1148
Country	:	US
Telephone Number	:	413-543-2101
Fax Number	:

Provider Business Practice Location Address
First Line	:	1655 BOSTON RD
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01129-1148
Country	:	US
Telephone Number	:	413-543-2101
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	12/12/2017

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