Provider Demographics
NPI:1285618025
Name:NORTHAMPTON PEDIATRIC DENTISTRY PC
Entity type:Organization
Organization Name:NORTHAMPTON PEDIATRIC DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEMAIO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:413-584-7773
Mailing Address - Street 1:264 ELM STREET
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060
Mailing Address - Country:US
Mailing Address - Phone:413-584-7773
Mailing Address - Fax:413-584-0684
Practice Address - Street 1:264 ELM STREET
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060
Practice Address - Country:US
Practice Address - Phone:413-584-7773
Practice Address - Fax:413-584-0684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA139491223P0221X
MADN203551223P0221X
MADN18563951223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty