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Individual

MICHAEL DOE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
434 N MAIN ST # 110, EAST LONGMEADOW, MA 01028-1805
(413) 526-9901
Mailing address
PO BOX 3189, SYRACUSE, NY 13220-3189
(866) 273-8204

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22254
MA

Other

Enumeration date
09/26/2008
Last updated
09/26/2008
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