Provider Demographics
NPI:1043470941
Name:MASSEY FAMILY DENTISTRY, P.C.
Entity Type:Organization
Organization Name:MASSEY FAMILY DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:TED
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:217-352-6232
Mailing Address - Street 1:1810 WOODFIELD DR
Mailing Address - Street 2:
Mailing Address - City:SAVOY
Mailing Address - State:IL
Mailing Address - Zip Code:61874-9505
Mailing Address - Country:US
Mailing Address - Phone:217-352-6232
Mailing Address - Fax:
Practice Address - Street 1:1810 WOODFIELD DR
Practice Address - Street 2:
Practice Address - City:SAVOY
Practice Address - State:IL
Practice Address - Zip Code:61874-9505
Practice Address - Country:US
Practice Address - Phone:217-352-6232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190236211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty