Western Mass Periodontics PC
NPI #1457709180 in Agawam, Massachusetts
Provider Information
- NPI Number
- 1457709180
- 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
- Jun 3, 2016
- Last Updated
- Jan 18, 2022
Practice Location
- Address
- 158 MAIN ST
- City
- Agawam
- State
- Massachusetts
- ZIP Code
- 01001
- Phone
- (413) 786-2341
Authorized Official
- Name
- LEAH ANN MAYLOTT
- Title
- CREDENTIALING ADMINISTRATOR
- Phone
- (860) 874-8198
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