Provider Demographics
NPI:1588806152
Name:CHICOPEE FAMILY DENTAL PC
Entity Type:Organization
Organization Name:CHICOPEE FAMILY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST /PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:BASH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-526-5042
Mailing Address - Street 1:30 SAINT JAMES AVE
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-2453
Mailing Address - Country:US
Mailing Address - Phone:413-592-2177
Mailing Address - Fax:413-592-3278
Practice Address - Street 1:30 SAINT JAMES AVE
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-2453
Practice Address - Country:US
Practice Address - Phone:413-592-2177
Practice Address - Fax:413-592-3278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-29
Last Update Date:2009-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA211351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty