Organization
BAYSTATE DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANN MARIE SANTOS (OFFICE MANAGER)
(413) 733-6651
Entity
Organization
Contact information
Practice address
1795 MAIN ST, SPRINGFIELD, MA 01103-1077
(413) 733-6651
Mailing address
1795 MAIN ST, SPRINGFIELD, MA 01103-1077
(413) 733-6651
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
15623
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9730460
—
MA
Enumeration date
05/17/2007
Last updated
08/22/2020
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