Provider Demographics
NPI:1225201627
Name:GARY R. ARCHAMBAULT, D.M.D., P.C.
Entity Type:Organization
Organization Name:GARY R. ARCHAMBAULT, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:ARCHAMBAULT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:413-737-6387
Mailing Address - Street 1:1284 ELM ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-1847
Mailing Address - Country:US
Mailing Address - Phone:413-737-6387
Mailing Address - Fax:413-746-4151
Practice Address - Street 1:1284 ELM ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-1847
Practice Address - Country:US
Practice Address - Phone:413-737-6387
Practice Address - Fax:413-746-4151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA143421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty