MEDICARE: AGAWAM DENTAL ARTS

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

General Provider Information

NPI Number	:	1992131197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGAWAM DENTAL ARTS

Provider Business Mailing Address
First Line	:	850 SPRINGFIELD ST
Second Line	:	SUITE 2
City	:	FEEDING HILLS
State	:	MA
Zip	:	01030-2243
Country	:	US
Telephone Number	:	413-786-0555
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 SPRINGFIELD ST
Second Line	:	SUITE 2
City	:	FEEDING HILLS
State	:	MA
Zip	:	01030-2243
Country	:	US
Telephone Number	:	413-786-0555
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL J CALABRESE
Credential	:	DMD, MAGD, MS
Telephone Number	:	413-786-0555

Provider Enumeration Date	:	09/19/2013
Last Update Date	:	09/19/2013

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