Provider Demographics
NPI:1104814474
Name:ST.GERMAIN, AMY G (DMD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:G
Last Name:ST.GERMAIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-2420
Mailing Address - Country:US
Mailing Address - Phone:413-525-0955
Mailing Address - Fax:413-517-0003
Practice Address - Street 1:10 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-2420
Practice Address - Country:US
Practice Address - Phone:413-525-0955
Practice Address - Fax:413-517-0003
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA189801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice