Organization
RIVERSIDE DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHANDRA MOHAN MANISH DMD (OWNER)
(603) 738-6808
Entity
Organization
Contact information
Practice address
235B MEMORIAL AVENUE, WEST SPRINGFIELD, MA 01028-2846
(603) 738-6808
(413) 285-8146
Mailing address
235B MEMORIAL AVENUE, WEST SPRINGFIELD, MA 01028-2846
(603) 738-6808
(413) 285-8146
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN1855134
MA
Other
Enumeration date
06/04/2013
Last updated
03/30/2015
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