Provider Demographics
NPI:1750643722
Name:CONNECTICUT RIVER VALLEY DENTISTS, PC
Entity Type:Organization
Organization Name:CONNECTICUT RIVER VALLEY DENTISTS, PC
Other - Org Name:THE VALLEY DENTISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUMEET
Authorized Official - Middle Name:
Authorized Official - Last Name:SAXENA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-687-5542
Mailing Address - Street 1:138 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01035-9533
Mailing Address - Country:US
Mailing Address - Phone:413-584-6275
Mailing Address - Fax:
Practice Address - Street 1:138 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01035-9533
Practice Address - Country:US
Practice Address - Phone:413-584-6275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-14
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN22332122300000X
MADN22331122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty