Provider Demographics
NPI:1356461891
Name:PHILIP C. IRVING,DDS,PC
Entity Type:Organization
Organization Name:PHILIP C. IRVING,DDS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:IRVING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:413-737-3700
Mailing Address - Street 1:1383 MAIN ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-1653
Mailing Address - Country:US
Mailing Address - Phone:413-737-3700
Mailing Address - Fax:413-736-6515
Practice Address - Street 1:1383 MAIN ST
Practice Address - Street 2:SUITE 301
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1653
Practice Address - Country:US
Practice Address - Phone:413-737-3700
Practice Address - Fax:413-736-6515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA129701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9713841Medicaid
MA0248509Medicaid