Provider Demographics
NPI:1063401131
Name:BAGLEY, GOODWIN & HRINDA PC
Entity type:Organization
Organization Name:BAGLEY, GOODWIN & HRINDA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:F
Authorized Official - Last Name:BAGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:413-772-0842
Mailing Address - Street 1:207 SILVER ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-1805
Mailing Address - Country:US
Mailing Address - Phone:413-772-0842
Mailing Address - Fax:413-773-5441
Practice Address - Street 1:207 SILVER ST
Practice Address - Street 2:SUITE 1
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-1805
Practice Address - Country:US
Practice Address - Phone:413-772-0842
Practice Address - Fax:413-773-5441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9743626Medicaid