Provider Demographics
NPI:1407900863
Name:TREMBLAY, DONALD A (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:A
Last Name:TREMBLAY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:104 UNION ST
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027
Mailing Address - Country:US
Mailing Address - Phone:413-527-3330
Mailing Address - Fax:413-527-1743
Practice Address - Street 1:104 UNION ST
Practice Address - Street 2:
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027
Practice Address - Country:US
Practice Address - Phone:413-527-3330
Practice Address - Fax:413-527-1743
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13730122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0250155Medicaid
MA961405OtherUNITED CONCORDIA