Provider Demographics
NPI:1649569955
Name:WESTERN MASS HOSPITAL DENTAL CLINIC
Entity Type:Organization
Organization Name:WESTERN MASS HOSPITAL DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:MERTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-420-2122
Mailing Address - Street 1:230 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-5144
Mailing Address - Country:US
Mailing Address - Phone:413-420-2122
Mailing Address - Fax:413-539-9472
Practice Address - Street 1:91 E MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-1801
Practice Address - Country:US
Practice Address - Phone:413-420-6260
Practice Address - Fax:413-562-3380
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOLYOKE HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4118261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental