Provider Demographics
NPI:1144036567
Name:WESTERN MASS PERIODONTICS & IMPLANT SPECIALISTS PC
Entity type:Organization
Organization Name:WESTERN MASS PERIODONTICS & IMPLANT SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-696-0100
Mailing Address - Street 1:271 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1748
Mailing Address - Country:US
Mailing Address - Phone:413-644-8894
Mailing Address - Fax:
Practice Address - Street 1:271 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1748
Practice Address - Country:US
Practice Address - Phone:413-644-8894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty