Organization
NORTHGATE DENTAL CENTER, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM MALAVE-VIDAL DMD (PRESIDENT)
(413) 747-0400
Entity
Organization
Contact information
Practice address
1985 MAIN ST STE 1, SPRINGFIELD, MA 01103-1072
(413) 747-0400
(413) 747-2440
Mailing address
PO BOX 2218, SPRINGFIELD, MA 01101-2218
(413) 747-0400
(413) 747-2440
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
18100
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9753371
—
MA
Enumeration date
03/11/2007
Last updated
08/22/2020
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