Provider Demographics
NPI:1386818458
Name:FAIRVIEW DENTAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:FAIRVIEW DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:413-533-6460
Mailing Address - Street 1:1682 MEMORIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020
Mailing Address - Country:US
Mailing Address - Phone:413-533-6460
Mailing Address - Fax:413-533-7034
Practice Address - Street 1:1682 MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020
Practice Address - Country:US
Practice Address - Phone:413-533-6460
Practice Address - Fax:413-533-7034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17057122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty