Provider Demographics
NPI:1609261650
Name:NEW ENGLAND DENTAL CARE
Entity Type:Organization
Organization Name:NEW ENGLAND DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHANDRA MOHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-738-6808
Mailing Address - Street 1:352 COOLEY STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01128
Mailing Address - Country:US
Mailing Address - Phone:603-738-6808
Mailing Address - Fax:
Practice Address - Street 1:132 CANTERBURY CIRCLE
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028
Practice Address - Country:US
Practice Address - Phone:603-738-6808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18551341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty