Provider Demographics
NPI:1992131197
Name:AGAWAM DENTAL ARTS
Entity type:Organization
Organization Name:AGAWAM DENTAL ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CALABRESE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MAGD, MS
Authorized Official - Phone:413-786-0555
Mailing Address - Street 1:850 SPRINGFIELD ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FEEDING HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:01030-2243
Mailing Address - Country:US
Mailing Address - Phone:413-786-0555
Mailing Address - Fax:
Practice Address - Street 1:850 SPRINGFIELD ST
Practice Address - Street 2:SUITE 2
Practice Address - City:FEEDING HILLS
Practice Address - State:MA
Practice Address - Zip Code:01030-2243
Practice Address - Country:US
Practice Address - Phone:413-786-0555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty