Provider Demographics
NPI:1033422944
Name:NEWTON STREET DENTAL, PC
Entity Type:Organization
Organization Name:NEWTON STREET DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:LEIGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:413-538-9604
Mailing Address - Street 1:488 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075-2010
Mailing Address - Country:US
Mailing Address - Phone:413-538-9604
Mailing Address - Fax:413-534-3533
Practice Address - Street 1:488 NEWTON ST
Practice Address - Street 2:
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-2010
Practice Address - Country:US
Practice Address - Phone:413-538-9604
Practice Address - Fax:413-534-3533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN20254122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty