Individual
DR. ROBERT ALLAN DESAUTELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
34 MARSDEN STREET, SPRINGFIELD, MA 01109-1615
(413) 733-8966
Mailing address
25 BRUUER AVE, WILBRAHAM, MA 01095-2210
(413) 596-2592
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
15009
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0260339
MASSHEALTH
MA
Enumeration date
07/28/2006
Last updated
07/08/2007
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