Provider Demographics
NPI:1720203292
Name:EDWARD SMOLA DMD
Entity Type:Organization
Organization Name:EDWARD SMOLA DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:SMOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:413-584-6557
Mailing Address - Street 1:63 EAST ST
Mailing Address - Street 2:
Mailing Address - City:HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01035-9790
Mailing Address - Country:US
Mailing Address - Phone:413-584-6557
Mailing Address - Fax:413-584-3462
Practice Address - Street 1:63 EAST ST
Practice Address - Street 2:
Practice Address - City:HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01035-9790
Practice Address - Country:US
Practice Address - Phone:413-584-6557
Practice Address - Fax:413-584-3462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA105521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA020010552MA01OtherANTHEM BLUE CROSS BLUE SH
MA845318OtherUNITED CONCORDIA