Organization
MEMORIAL DRIVE DENTAL ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY J RUSIECKI DDS (PRESIDENT)
(413) 593-5772
Entity
Organization
Contact information
Practice address
1176 MEMORIAL DRIVE, CHICOPEE, MA 01020-3960
(413) 593-5772
(413) 593-5199
Mailing address
1176 MEMORIAL DRIVE, CHICOPEE, MA 01020-3960
(413) 593-5772
(413) 593-5199
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
10/04/2006
Last updated
08/22/2020
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