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SPRINGFIELD SMILES YOUTH DENTISTRY LLC NPI 1568533727


NPI Information

NPI: 1568533727
Provider Name: SPRINGFIELD SMILES YOUTH DENTISTRY, LLC
Classification: Dentist - 1223G0001X
Entity Type: Organization

Specialization: General Practice

Address:
376 COOLEY ST
SPRINGFIELD, MA
ZIP 01128
Phone: (413) 796-1616
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SPRINGFIELD SMILES YOUTH DENTISTRY, LLC is a general practice dentist in Springfield, MA. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. SPRINGFIELD SMILES YOUTH DENTISTRY, LLC NPI is 1568533727. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

376 COOLEY ST
SPRINGFIELD, MA
ZIP 01128-144
Phone: (413) 796-1616
Fax: (413) 796-1617

The provider's authorized official is Jenell Stump .
The authorized official title is Manager, Licensing & Credentialing and has the following contact phone number (615) 750-0343.

The enumeration date for this NPI number is 11/10/2006 and was last updated on 7/9/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223P0221XDentistPediatric DentistryNo
21223X0400XDentistOrthodontics and Dentofacial OrthopedicsNo
31223G0001XDentistGeneral PracticeYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1110070584AMEDICAIDMASSACHUSETTS
21568533727MEDICAIDCONNECTICUT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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