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Organization
WESTERN MASS PERIODONTICS PC
Active
Organization
WESTERN MASS PERIODONTICS PC
Active
Parent organization
WESTERN MASS PERIODONTICS PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
WESTERN MASS PERIODONTICS PC
Authorized official
LEAH ANN MAYLOTT (CREDENTIALING ADMINISTRATOR)
(860) 874-8198
Entity
Organization
Contact information
Practice address
75 BERLIN RD STE 108, CROMWELL, CT 06416-2633
(860) 635-1515
Mailing address
65 ELM ST, WORCESTER, MA 01609-2547
(860) 874-8198
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
01/18/2022
Last updated
01/18/2022
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