Provider Demographics
NPI:1417671546
Name:SPRINGFIELD FAMILY DENTAL PC
Entity Type:Organization
Organization Name:SPRINGFIELD FAMILY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-505-7981
Mailing Address - Street 1:945 CONCORD ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-4613
Mailing Address - Country:US
Mailing Address - Phone:508-505-7981
Mailing Address - Fax:
Practice Address - Street 1:373 BROADWAY
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-2809
Practice Address - Country:US
Practice Address - Phone:617-887-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental