Provider Demographics
NPI:1396046132
Name:SUGARLOAF DENTAL PC
Entity Type:Organization
Organization Name:SUGARLOAF DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BOWERS
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:413-665-4575
Mailing Address - Street 1:4 PARK ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH DEERFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01373-1035
Mailing Address - Country:US
Mailing Address - Phone:413-665-4575
Mailing Address - Fax:413-665-9613
Practice Address - Street 1:4 PARK ST
Practice Address - Street 2:
Practice Address - City:SOUTH DEERFIELD
Practice Address - State:MA
Practice Address - Zip Code:01373-1035
Practice Address - Country:US
Practice Address - Phone:413-665-4575
Practice Address - Fax:413-665-9613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty