Western Mass Periodontics PC
NPI #1295217065 in Worcester, Massachusetts
Provider Information
- NPI Number
- 1295217065
- Entity Type
- Organization
- Organization Name
- Western Mass Periodontics PC
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- WESTERN MASS PERIODONTICS PC
- Primary Specialty
- Dentist - Periodontics
- Enumeration Date
- Aug 29, 2018
- Last Updated
- Aug 19, 2022
Practice Location
- Address
- 65 ELM ST
- City
- Worcester
- State
- Massachusetts
- ZIP Code
- 01609-2547
- Phone
- (508) 363-4400
Authorized Official
- Name
- LEAH ANN MAYLOTT
- Title
- CREDENTIALING ADMINISTRATOR
- Phone
- (860) 874-8198
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