Provider Demographics
NPI:1376561134
Name:AMHERST DENTAL GROUP, LLP
Entity Type:Organization
Organization Name:AMHERST DENTAL GROUP, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:F
Authorized Official - Last Name:PRENTISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-253-9582
Mailing Address - Street 1:650 MAIN ST
Mailing Address - Street 2:STE. 1
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2435
Mailing Address - Country:US
Mailing Address - Phone:413-253-9582
Mailing Address - Fax:413-253-0796
Practice Address - Street 1:650 MAIN ST
Practice Address - Street 2:STE. 1
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2435
Practice Address - Country:US
Practice Address - Phone:413-253-9582
Practice Address - Fax:413-253-0796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA187421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty