Provider Demographics
NPI:1982632378
Name:MEAD, DONALD H (DDS)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:H
Last Name:MEAD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 ASHLAND ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01247-4513
Mailing Address - Country:US
Mailing Address - Phone:413-663-3378
Mailing Address - Fax:413-663-3459
Practice Address - Street 1:176 ASHLAND ST
Practice Address - Street 2:
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247-4513
Practice Address - Country:US
Practice Address - Phone:413-663-3378
Practice Address - Fax:413-663-3459
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA140021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA70010000X08119OtherBLUE CROSS BLUE SHIELD
MA0252514Medicaid