Provider Demographics
NPI:1962226589
Name:EAST LONGMEADOW DENTAL PLLC
Entity type:Organization
Organization Name:EAST LONGMEADOW DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:
Authorized Official - Last Name:EICHENLAUB
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-515-2949
Mailing Address - Street 1:10 BIRCHMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01035-3555
Mailing Address - Country:US
Mailing Address - Phone:617-515-2949
Mailing Address - Fax:
Practice Address - Street 1:448 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-1861
Practice Address - Country:US
Practice Address - Phone:617-515-2949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty