Organization
WESTERN MASS PERIODONTICS PC
Active
Parent organization
WESTERN MASS PERIODONTICS PC
Other names
Nobel Perio
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
158 MAIN ST, AGAWAM, MA 01001
(413) 786-2341
Mailing address
65 ELM ST, WORCESTER, MA 01609-2547
(860) 874-8198
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
19671
MA
Other
Enumeration date
06/03/2016
Last updated
01/18/2022
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