Organization
THE LOOSE TOOTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNIFER HAUSCHILD RDH, PHDH (OWNER, OPPERATOR)
14138886767
Entity
Organization
Contact information
Practice address
874 PROSPECT ST, CHICOPEE, MA 01020-3107
(413) 888-6767
(413) 888-6766
Mailing address
874 PROSPECT ST, CHICOPEE, MA 01020-3107
(413) 888-6767
(413) 888-6766
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
DH11413
MA
Other
Enumeration date
03/02/2011
Last updated
03/02/2011
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