| Western Mass Periodontics Pc | |
|
158 Main St Agawam MA 01001 | |
| (413) 786-2341 | |
| Not Available |
| Full Name | Western Mass Periodontics Pc |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 158 Main St, Agawam, Massachusetts |
| Authorized Official Name and Position | Leah Ann Maylott (CREDENTIALING ADMINISTRATOR) |
| Authorized Official Contact | 8608748198 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Western Mass Periodontics Pc 65 Elm St Worcester MA 01609-2547 Ph: (860) 874-8198 | Western Mass Periodontics Pc 158 Main St Agawam MA 01001 Ph: (413) 786-2341 |
| NPI Number | 1457709180 |
|---|---|
| Provider Enumeration Date | 06/03/2016 |
| Last Update Date | 01/18/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457709180 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | 19671 (Massachusetts) | Primary |
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