Provider Demographics
NPI:1124243555
Name:DRS. MACKLER, SIUREK AND ASSOCIATES
Entity type:Organization
Organization Name:DRS. MACKLER, SIUREK AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERIC
Authorized Official - Middle Name:S
Authorized Official - Last Name:MACKLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MA
Authorized Official - Phone:413-747-9224
Mailing Address - Street 1:46 DAGGETT DR
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-4638
Mailing Address - Country:US
Mailing Address - Phone:413-747-9224
Mailing Address - Fax:413-747-0117
Practice Address - Street 1:46 DAGGETT DR
Practice Address - Street 2:SUITE 2C
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-4638
Practice Address - Country:US
Practice Address - Phone:413-747-9224
Practice Address - Fax:413-747-0117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA115801223G0001X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty