Provider Demographics
NPI:1396897823
Name:MCNALLY BROTHERS
Entity type:Organization
Organization Name:MCNALLY BROTHERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:R
Authorized Official - Last Name:DESESA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:413-788-9621
Mailing Address - Street 1:75 VAN DEENE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-3213
Mailing Address - Country:US
Mailing Address - Phone:413-788-9621
Mailing Address - Fax:413-788-0103
Practice Address - Street 1:75 VAN DEENE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089
Practice Address - Country:US
Practice Address - Phone:413-788-9621
Practice Address - Fax:413-788-0103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty