Provider Demographics
NPI:1386749828
Name:PIECUCH, STANLEY EDMUND (DMD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:EDMUND
Last Name:PIECUCH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONSON
Mailing Address - State:MA
Mailing Address - Zip Code:01057-1318
Mailing Address - Country:US
Mailing Address - Phone:413-267-5139
Mailing Address - Fax:
Practice Address - Street 1:80 MAIN ST
Practice Address - Street 2:
Practice Address - City:MONSON
Practice Address - State:MA
Practice Address - Zip Code:01057-1318
Practice Address - Country:US
Practice Address - Phone:413-267-5139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA129061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0246336Medicaid