Provider Demographics
NPI:1477867612
Name:SPRINGFIELD COMMUNITY DENTAL CLINIC
Entity Type:Organization
Organization Name:SPRINGFIELD COMMUNITY DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BREINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-420-2110
Mailing Address - Street 1:230 MAPLE ST
Mailing Address - Street 2:PO BOX 6260
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-5144
Mailing Address - Country:US
Mailing Address - Phone:413-420-2200
Mailing Address - Fax:
Practice Address - Street 1:1 ARMORY SQ
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-1700
Practice Address - Country:US
Practice Address - Phone:413-420-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOLYOKE HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4118261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental